Provider Demographics
NPI:1104031277
Name:ZAMBONI, MARLON A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARLON
Middle Name:A
Last Name:ZAMBONI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 E MICHELLE ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-5228
Mailing Address - Country:US
Mailing Address - Phone:213-344-9795
Mailing Address - Fax:
Practice Address - Street 1:2105 BEVERLY BLVD STE 119
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2255
Practice Address - Country:US
Practice Address - Phone:213-413-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice