MEDICARE: MARCEL DENTAL AND ANESTHESIA SERVICES, PPLC

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
1	1223G0001X	General Practice Dentistry	17823	TX

General Provider Information

NPI Number	:	1386933760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCEL DENTAL AND ANESTHESIA SERVICES, PPLC

Provider Business Mailing Address
First Line	:	6100 CAMP BOWIE BLVD
Second Line	:	SUITE 22
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5528
Country	:	US
Telephone Number	:	817-264-7899
Fax Number	:	682-224-8559

Provider Business Practice Location Address
First Line	:	6100 CAMP BOWIE BLVD
Second Line	:	SUITE 22
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5528
Country	:	US
Telephone Number	:	817-264-7899
Fax Number	:	682-224-8559

Authorized Official
Title or Position	:	GENERAL DENTIST/ OWNER
Name	:	DR. PERRY LEE MARCEL
Credential	:	D.D.O
Telephone Number	:	817-264-7899

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	04/06/2011

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