Healthcare Provider Details

I. General information

NPI: 1811329956
Provider Name (Legal Business Name): MARCKAREN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 N 400 E
NORTH OGDEN UT
84414-7210
US

IV. Provider business mailing address

PO BOX 13167
OGDEN UT
84412-3167
US

V. Phone/Fax

Practice location:
  • Phone: 801-782-9544
  • Fax: 801-786-0557
Mailing address:
  • Phone: 801-782-9544
  • Fax: 801-786-0557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number931439079922
License Number StateUT

VIII. Authorized Official

Name: DR. MARC ADAM COLLMAN
Title or Position: OWNER
Credential: DDS
Phone: 801-782-9544