Healthcare Provider Details

I. General information

NPI: 1457389736
Provider Name (Legal Business Name): MARLIND ALAN STILES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 WALNUT ST 3RD FLOOR, COB
PHILADELPHIA PA
19107-5211
US

IV. Provider business mailing address

909 WALNUT ST 3RD FLOOR, COB
PHILADELPHIA PA
19107-5211
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6215
  • Fax: 215-923-9189
Mailing address:
  • Phone: 215-955-6215
  • Fax: 215-923-9189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS030890L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: