MEDICARE: DR. DONALD IRVIN MARLER D.D.S.

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	4481	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7846	OTHER	KS	BLUE CROSS BLUE SHIELD #
2	4481	OTHER	KS	STATE LICENSE

General Provider Information

NPI Number	:	1790763639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD IRVIN MARLER D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 4071
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67204-0071
Country	:	US
Telephone Number	:	316-832-0141
Fax Number	:	316-832-0142

Provider Business Practice Location Address
First Line	:	2563 N HOOD AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67204-5736
Country	:	US
Telephone Number	:	316-832-0141
Fax Number	:	316-832-0142

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2005
Last Update Date	:	07/08/2007

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