Provider Demographics
NPI:1306821665
Name:MARCOOT, RALPH (DDS)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:MARCOOT
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:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-0191
Mailing Address - Country:US
Mailing Address - Phone:410-651-9852
Mailing Address - Fax:410-651-1279
Practice Address - Street 1:12137 ELM ST
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-1358
Practice Address - Country:US
Practice Address - Phone:410-651-9852
Practice Address - Fax:410-651-1279
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD48321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4832OtherCIGNA
521860379OtherDELTA DENTAL
054635OtherJHHC
190081OtherANTHEM
9179128OtherDORAL
MD119591300Medicaid
DG26TH 521860379-03OtherCAREFIRST
MD288504201Medicaid
521860379OtherMETLIFE
MD288504201Medicaid