Provider Demographics
NPI:1205815719
Name:MARLER, DONALD LARRY (DMD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:LARRY
Last Name:MARLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-2610
Mailing Address - Country:US
Mailing Address - Phone:864-878-7915
Mailing Address - Fax:864-878-7960
Practice Address - Street 1:504 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2610
Practice Address - Country:US
Practice Address - Phone:864-878-7915
Practice Address - Fax:864-878-7960
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX2669Medicaid