Healthcare Provider Details

I. General information

NPI: 1831223833
Provider Name (Legal Business Name): STEPHEN C MARQUARD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 DREW AVE SE STE 202
MADELIA MN
56062-1870
US

IV. Provider business mailing address

1424 WELLINGTON CRES
FARIBAULT MN
55021-6729
US

V. Phone/Fax

Practice location:
  • Phone: 507-642-8742
  • Fax: 507-642-2926
Mailing address:
  • Phone: 507-332-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD9149
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: