Provider Demographics
NPI:1144421728
Name:ANNA T. MARCHENKO, DMD, PC
Entity Type:Organization
Organization Name:ANNA T. MARCHENKO, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MARCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-671-1833
Mailing Address - Street 1:10125 VERREE RD STE 307
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3611
Mailing Address - Country:US
Mailing Address - Phone:215-671-1833
Mailing Address - Fax:215-671-0130
Practice Address - Street 1:10125 VERREE RD STE 307
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3611
Practice Address - Country:US
Practice Address - Phone:215-671-1833
Practice Address - Fax:215-671-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029134L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty