Provider Demographics
NPI:1093880031
Name:MARKS, NOELLE OLIVIA (DDS)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:OLIVIA
Last Name:MARKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:OLIVIA
Other - Last Name:MEACHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:WI
Mailing Address - Zip Code:54448-0187
Mailing Address - Country:US
Mailing Address - Phone:715-443-2200
Mailing Address - Fax:715-443-3749
Practice Address - Street 1:500 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:WI
Practice Address - Zip Code:54448-0187
Practice Address - Country:US
Practice Address - Phone:715-443-2200
Practice Address - Fax:715-443-3749
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist