Provider Demographics
NPI:1376787762
Name:DENTAL ASSOCIATES OF MARQUETTE PLLP
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF MARQUETTE PLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:906-228-9594
Mailing Address - Street 1:708 CHIPPEWA SQ
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4814
Mailing Address - Country:US
Mailing Address - Phone:906-228-9594
Mailing Address - Fax:906-228-9196
Practice Address - Street 1:708 CHIPPEWA SQ
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4814
Practice Address - Country:US
Practice Address - Phone:906-228-9594
Practice Address - Fax:906-228-9196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMM0159011223G0001X
MIMS191011223G0001X
MIRP0100171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty