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General NPI Number Information
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NPI Number | 1780797308
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Entity Type | Organization
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Legal Business Name | JACK M. MARINCEL, D.D.S., P.C.
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6060 TELEGRAPH RD SUITE H
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City | SAINT LOUIS
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State | MO
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Zip | 63129-4762
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Country | US
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Telephone | 314-846-1480
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Fax |
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Provider Business Mailing Address
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Address Line | 6060 TELEGRAPH RD SUITE H
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City | SAINT LOUIS
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State | MO
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Zip | 63129-4762
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Country | US
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Telephone | 314-846-1480
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN MICHAEL MARINCEL
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Credential | D.D.S.
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Telephone | 314-846-1480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 13331
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License Number State | MO
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