Provider Demographics
NPI:1326259698
Name:MARION DENTAL ASSOCIATES INC
Entity Type:Organization
Organization Name:MARION DENTAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-387-4804
Mailing Address - Street 1:1241 EAST CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:44302
Mailing Address - Country:US
Mailing Address - Phone:740-387-4804
Mailing Address - Fax:740-382-9901
Practice Address - Street 1:1241 EAST CENTER ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:44302
Practice Address - Country:US
Practice Address - Phone:740-387-4804
Practice Address - Fax:740-382-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty