Provider Demographics
NPI:1073511317
Name:MARCIN, JACQUELINE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ANN
Last Name:MARCIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2835
Mailing Address - Country:US
Mailing Address - Phone:717-757-3851
Mailing Address - Fax:717-840-1672
Practice Address - Street 1:1820 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2835
Practice Address - Country:US
Practice Address - Phone:717-757-3851
Practice Address - Fax:717-840-1672
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD5025765L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist