Healthcare Provider Details

I. General information

NPI: 1295872430
Provider Name (Legal Business Name): MARCOS CID D.D.S. M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 STOCKING AVE NW APT 408
GRAND RAPIDS MI
49504-5153
US

IV. Provider business mailing address

736 STOCKING AVE NW
GRAND RAPIDS MI
49504-5153
US

V. Phone/Fax

Practice location:
  • Phone: 616-214-7865
  • Fax: 616-328-6770
Mailing address:
  • Phone: 616-214-7865
  • Fax: 616-328-6770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3479
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: