MEDICARE: IAN WILLIAM MARION 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	1223P0221X	Pediatric Dentistry	64448	CA

General Provider Information

NPI Number	:	1811253156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN WILLIAM MARION D.D.S.

Provider Business Mailing Address
First Line	:	2200 X STREET BROADWAY ALLEY
Second Line	:	COLLEGE OF DENTISTRY ROOM 254
City	:	SACRAMENTO
State	:	CA
Zip	:	95818
Country	:	US
Telephone Number	:	916-245-0305
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 BROADWAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-2504
Country	:	US
Telephone Number	:	916-245-0305
Fax Number	:

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

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	03/24/2026

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