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General NPI Number Information
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NPI Number | 1699012047
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Entity Type | Organization
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Legal Business Name | M.G. MARQUEZ, DMD,MSD,PC.
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Dates
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Enumeration Date | 01/04/2013
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 57 CODJER LN
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City | SUDBURY
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State | MA
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Zip | 01776-2302
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Country | US
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Telephone | 978-443-8814
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Fax | 978-440-8514
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Provider Business Mailing Address
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Address Line | 57 CODJER LN
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City | SUDBURY
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State | MA
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Zip | 01776-2302
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Country | US
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Telephone | 978-443-8814
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Fax | 978-440-8514
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIA GABRIELA MARQUEZ
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Credential | D.M.D,M.S.D.
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Telephone | 978-443-8814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 21147
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License Number State | MA
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