MEDICARE: MARION FAMILY SMILES, P.A.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1891450037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARION FAMILY SMILES, P.A.

Provider Business Mailing Address
First Line	:	400 RIVERWALK TER STE 250
Second Line	:
City	:	JENKS
State	:	OK
Zip	:	74037-5619
Country	:	US
Telephone Number	:	918-998-0996
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 MELVIN ST
Second Line	:
City	:	MARION
State	:	KS
Zip	:	66861-1235
Country	:	US
Telephone Number	:	620-382-2520
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CREED CARDON
Credential	:	DDS
Telephone Number	:	918-998-0996

Provider Enumeration Date	:	11/02/2021
Last Update Date	:	11/02/2021

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