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General NPI Number Information
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NPI Number | 1629328638
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Entity Type | Organization
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Legal Business Name | STEVEN P MARINKOVICH DDS
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 02/14/2014
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Provider Practice Location Address
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Address Line | 5225 TACOMA MALL BLVD SUITE E-104
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City | TACOMA
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State | WA
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Zip | 98409-7018
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Country | US
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Telephone | 253-474-3223
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Fax | 253-473-6762
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Provider Business Mailing Address
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Address Line | 5225 TACOMA MALL BLVD SUITE E-104
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City | TACOMA
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State | WA
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Zip | 98409-7018
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Country | US
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Telephone | 253-474-3223
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Fax | 253-473-6762
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | STEVEN P MARINKOVICH
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Credential | DDS, ABDSM
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Telephone | 253-474-3223
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | DE00004767
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License Number State | WA
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