Healthcare Provider Details

I. General information

NPI: 1720634447
Provider Name (Legal Business Name): MARQUEZ DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2019
Last Update Date: 08/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 N HIGHWAY 171
GODLEY TX
76044-3466
US

IV. Provider business mailing address

8905 N HIGHWAY 171
GODLEY TX
76044-3466
US

V. Phone/Fax

Practice location:
  • Phone: 682-282-0806
  • Fax:
Mailing address:
  • Phone: 682-282-0806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERICK MARQUEZ
Title or Position: MANAGING MEMBER
Credential: DDS
Phone: 432-556-4528