Healthcare Provider Details

I. General information

NPI: 1043497183
Provider Name (Legal Business Name): MARLIND HARRY STILES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3308 STATE STREET
ERIE PA
16508-2830
US

IV. Provider business mailing address

3308 STATE STREET
ERIE PA
16508-2830
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-6345
  • Fax: 814-456-8193
Mailing address:
  • Phone: 814-452-6345
  • Fax: 814-456-8193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS017365L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: