Provider Demographics
NPI:1043768922
Name:MARQUEZDDSPROFESIONALCORPORATION
Entity Type:Organization
Organization Name:MARQUEZDDSPROFESIONALCORPORATION
Other - Org Name:SANTAFEDENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-484-0808
Mailing Address - Street 1:10009 ORR AND DAY RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3506
Mailing Address - Country:US
Mailing Address - Phone:562-484-0808
Mailing Address - Fax:562-484-0804
Practice Address - Street 1:10009 ORR AND DAY RD
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3506
Practice Address - Country:US
Practice Address - Phone:562-484-0808
Practice Address - Fax:562-484-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty