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NPI Code Detail

MEDICARE: DR. GREGORY ALBERT MARZOLF DDS

MEDICARE:  DR. GREGORY ALBERT MARZOLF  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2744SC

General Provider Information

NPI Number : 1265578371
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY ALBERT MARZOLF DDS
Provider Business Mailing Address
First Line : 5302 HIGHWAY 76
Second Line :
City : PENDLETON
State : SC
Zip : 29670-9139
Country : US
Telephone Number : 864-261-3436
Fax Number :
Provider Business Practice Location Address
First Line : 5302 HIGHWAY 76
Second Line :
City : PENDLETON
State : SC
Zip : 29670-9139
Country : US
Telephone Number : 864-261-3436
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 07/08/2007

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Directions to “ DR. GREGORY ALBERT MARZOLF DDS” Practice Location

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