Provider Demographics
NPI:1073843025
Name:MARLEY, ROSS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:MARLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 HALIBUT POINT RD
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7301
Mailing Address - Country:US
Mailing Address - Phone:907-747-6050
Mailing Address - Fax:907-747-3706
Practice Address - Street 1:423 HALIBUT POINT RD
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7301
Practice Address - Country:US
Practice Address - Phone:907-747-6050
Practice Address - Fax:907-747-3706
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1311122300000X
WADE 60126448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist