Provider Demographics
NPI:1316038086
Name:REXAN, MARIANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:
Last Name:REXAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1304
Mailing Address - Country:US
Mailing Address - Phone:415-566-7414
Mailing Address - Fax:
Practice Address - Street 1:3003 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4009
Practice Address - Country:US
Practice Address - Phone:415-346-9173
Practice Address - Fax:415-346-9207
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice