Provider Demographics
NPI:1164697553
Name:MARLEY & HARROD DENTISTRY, PC
Entity Type:Organization
Organization Name:MARLEY & HARROD DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MARLEY-HARROD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-842-4646
Mailing Address - Street 1:6532 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-4812
Mailing Address - Country:US
Mailing Address - Phone:405-842-4646
Mailing Address - Fax:405-840-5803
Practice Address - Street 1:6532 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-4812
Practice Address - Country:US
Practice Address - Phone:405-842-4646
Practice Address - Fax:405-840-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty