Provider Demographics
NPI:1073806998
Name:CORA A MARSAW DDS PA
Entity Type:Organization
Organization Name:CORA A MARSAW DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CORA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARSAW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,PA
Authorized Official - Phone:972-270-9647
Mailing Address - Street 1:3605 I-30 WEST
Mailing Address - Street 2:SUITE -B
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:972-270-9647
Mailing Address - Fax:972-270-9648
Practice Address - Street 1:3605 INTERSTATE 30
Practice Address - Street 2:SUITE B
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2670
Practice Address - Country:US
Practice Address - Phone:972-270-9647
Practice Address - Fax:972-270-9648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0158051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX646307OtherDELTA CARE FACILITY ID
TX008994801Medicaid
TX405623OtherUNITED CONCORDIA PROVIDER
TX250578OtherCIGNA FACILITY ID
TX4001093OtherGUARDIAN PROVIDER NUMBER DVILLE
TX0009003OtherFORTTIS FACILITY ID
TX4001092OtherGUARDIAN PROVIDER NUMBER MESQUITE