Provider Demographics
NPI:1417117995
Name:ETIENNE, MARC OREL (DDS)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:OREL
Last Name:ETIENNE
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 1:1786 ANGELIQUE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1202
Mailing Address - Country:US
Mailing Address - Phone:201-362-3791
Mailing Address - Fax:
Practice Address - Street 1:4800 BRIARCLIFF RD NE STE 2037
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2741
Practice Address - Country:US
Practice Address - Phone:770-493-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0137441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice