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General NPI Number Information
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NPI Number | 1962868802
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Entity Type | Organization
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Legal Business Name | MARPLE DENTAL, INC.
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 2004 SPROUL RD STE 304
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City | BROOMALL
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State | PA
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Zip | 19008-3511
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Country | US
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Telephone | 610-359-8181
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Fax | 610-359-8111
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Provider Business Mailing Address
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Address Line | 2004 SPROUL RD STE 304
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City | BROOMALL
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State | PA
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Zip | 19008-3511
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Country | US
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Telephone | 610-359-8181
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Fax | 610-359-8111
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGES MARTIN
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Credential | D.M.D.
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Telephone | 610-359-8181
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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 | DS-025838 L
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License Number State | PA
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