Healthcare Provider Details

I. General information

NPI: 1780979245
Provider Name (Legal Business Name): DAVID MARCHANT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 MONTGOMERY BLVD NE E-1
ALBUQUERQUE NM
87109-1308
US

IV. Provider business mailing address

7301 STATE HIGHWAY 161 STE 198
IRVING TX
75039-2880
US

V. Phone/Fax

Practice location:
  • Phone: 505-872-4867
  • Fax:
Mailing address:
  • Phone: 972-869-3789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD3499
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: