Healthcare Provider Details

I. General information

NPI: 1144303363
Provider Name (Legal Business Name): MARCIA L PRESTON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 EAST ELM
REPUBLIC MO
65738
US

IV. Provider business mailing address

604 EAST ELM
REPUBLIC MO
65738
US

V. Phone/Fax

Practice location:
  • Phone: 417-732-7874
  • Fax: 417-732-5084
Mailing address:
  • Phone: 417-732-7874
  • Fax: 417-732-5084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2002011186
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: