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General NPI Number Information
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NPI Number | 1255510988
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Entity Type | Organization
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Legal Business Name | MARDEN DENTAL
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 10322 MANCHESTER RD
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City | SAINT LOUIS
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State | MO
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Zip | 63122-1521
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Country | US
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Telephone | 314-822-4521
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Fax | 314-822-4527
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Provider Business Mailing Address
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Address Line | 10322 MANCHESTER RD
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City | SAINT LOUIS
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State | MO
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Zip | 63122-1521
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Country | US
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Telephone | 314-822-4521
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Fax | 314-822-4527
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARSHA L MARDEN
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Credential | DMD
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Telephone | 314-822-4521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE015190
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License Number State | MO
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