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NPI Code Detail

MEDICARE: DR. CORBIN MATTHEW MARCHACK DDS

MEDICARE: DR. CORBIN MATTHEW MARCHACK 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 Dentistry2005015591MO

General Provider Information

NPI Number : 1770621468
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CORBIN MATTHEW MARCHACK DDS
Provider Business Mailing Address
First Line : 4003 SNOW LEOPARD DR
Second Line :
City : COLUMBIA
State : MO
Zip : 65202-6280
Country : US
Telephone Number : 573-874-9957
Fax Number :
Provider Business Practice Location Address
First Line : 3306 EMERALD LN
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-6877
Country : US
Telephone Number : 573-634-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2007
Last Update Date : 07/08/2007

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