Provider Demographics
NPI:1407058845
Name:G. MARQUEZ, D.D.S., INC
Entity Type:Organization
Organization Name:G. MARQUEZ, D.D.S., INC
Other - Org Name:OTAY LAKES SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-934-6620
Mailing Address - Street 1:2452 FENTON STREET
Mailing Address - Street 2:SUITE C-200
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914
Mailing Address - Country:US
Mailing Address - Phone:619-934-6620
Mailing Address - Fax:619-934-4503
Practice Address - Street 1:2452 FENTON STREET
Practice Address - Street 2:SUITE C-200
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914
Practice Address - Country:US
Practice Address - Phone:619-934-6620
Practice Address - Fax:619-934-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA387161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB38716-01OtherDENTICAL