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General NPI Number Information
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NPI Number | 1316141732
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Entity Type | Individual
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Provider Name | MARSHA E MOUTON DDS
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Gender | Female
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 6820 LA TIJERA BLVD STE 205
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City | LOS ANGELES
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State | CA
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Zip | 90045-1908
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Country | US
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Telephone | 310-256-4326
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Fax | 310-835-0088
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Provider Business Mailing Address
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Address Line | 112 S MARKET ST STE 404
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City | INGLEWOOD
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State | CA
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Zip | 90301-1712
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Country | US
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Telephone | 310-890-3100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 40688
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40688
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License Number State | CA
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