Healthcare Provider Details

I. General information

NPI: 1699012047
Provider Name (Legal Business Name): M.G. MARQUEZ, DMD,MSD,PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 CODJER LN
SUDBURY MA
01776-2302
US

IV. Provider business mailing address

57 CODJER LN
SUDBURY MA
01776-2302
US

V. Phone/Fax

Practice location:
  • Phone: 978-443-8814
  • Fax: 978-440-8514
Mailing address:
  • Phone: 978-443-8814
  • Fax: 978-440-8514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21147
License Number StateMA

VIII. Authorized Official

Name: DR. MARIA GABRIELA MARQUEZ
Title or Position: OWNER
Credential: D.M.D,M.S.D.
Phone: 978-443-8814