Provider Demographics
NPI:1407990880
Name:TARAGIN, MARVIN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:M
Last Name:TARAGIN
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 1:46890 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-3819
Mailing Address - Country:US
Mailing Address - Phone:586-731-3950
Mailing Address - Fax:
Practice Address - Street 1:46890 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-3819
Practice Address - Country:US
Practice Address - Phone:586-731-3950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010115041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11504OtherDENTAL LICENSE NO.
MI382306702OtherMICHIGAN TAX ID NUMBER