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General NPI Number Information
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NPI Number | 1205490257
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Entity Type | Organization
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Legal Business Name | MARLIN FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/25/2019
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Last Update Date | 03/17/2020
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Provider Practice Location Address
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Address Line | 110 CHURCH ST
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City | MARLIN
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State | TX
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Zip | 76661-2809
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Country | US
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Telephone | 254-883-3070
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Fax |
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Provider Business Mailing Address
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Address Line | 110 CHURCH ST
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City | MARLIN
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State | TX
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Zip | 76661-2809
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Country | US
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Telephone | 254-883-3070
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | VANI PAVAN
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Credential | MS
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Telephone | 254-883-3070
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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 |
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License Number State |
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