Provider Demographics
NPI:1104393826
Name:NELSON J. MAR DDS PC
Entity Type:Organization
Organization Name:NELSON J. MAR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:623-536-6845
Mailing Address - Street 1:5220 N. DYSART RD. #144
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340
Mailing Address - Country:US
Mailing Address - Phone:623-536-6845
Mailing Address - Fax:623-536-7989
Practice Address - Street 1:5220 N. DYSART RD #144
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340
Practice Address - Country:US
Practice Address - Phone:623-536-6845
Practice Address - Fax:623-536-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty