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General NPI Number Information
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NPI Number | 1073806998
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Entity Type | Organization
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Legal Business Name | CORA A MARSAW DDS PA
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 3605 INTERSTATE 30 SUITE B
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City | MESQUITE
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State | TX
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Zip | 75150-2670
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Country | US
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Telephone | 972-270-9647
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Fax | 972-270-9648
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Provider Business Mailing Address
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Address Line | 3605 I-30 WEST SUITE -B
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City | MESQUITE
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State | TX
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Zip | 75150
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Country | US
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Telephone | 972-270-9647
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Fax | 972-270-9648
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Authorized Official
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Title or Position | PERIODONTIST
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Name | MS. CORA A MARSAW
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Credential | D.D.S.,P.A.
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Telephone | 972-270-9647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 015805
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License Number State | TX
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