=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811253156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IAN WILLIAM MARION D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2012
-----------------------------------------------------
Last Update Date | 06/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 X ST
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95818-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-245-0305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 S PAULINA ST # MC850 COLLEGE OF DENTISTRY ROOM 269-D
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60612-7210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-413-9651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 64448
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------