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General NPI Number Information
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NPI Number | 1841365715
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Entity Type | Organization
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Legal Business Name | SICILIA MARZOUK D.D.S,INC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1214 1/2 S GREENWOOD AVE
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City | MONTEBELLO
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State | CA
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Zip | 90640-6329
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Country | US
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Telephone | 323-728-3272
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Fax | 323-728-3292
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Provider Business Mailing Address
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Address Line | 1214 1/2 S GREENWOOD AVE
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City | MONTEBELLO
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State | CA
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Zip | 90640-6329
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Country | US
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Telephone | 323-728-3272
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Fax | 323-728-3292
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SICILIA CECILE MARZOUK
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Credential | D.D.S
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Telephone | 323-728-3272
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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 | B41474
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License Number State | CA
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