Provider Demographics
NPI:1417906207
Name:MARCHI, EDWARD J (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:MARCHI
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 1:511 E MAIN ST
Mailing Address - Street 2:POST OFFICE BOX 525
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537
Mailing Address - Country:US
Mailing Address - Phone:541-582-1107
Mailing Address - Fax:541-582-1519
Practice Address - Street 1:511 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537
Practice Address - Country:US
Practice Address - Phone:541-582-1107
Practice Address - Fax:541-582-1519
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD57201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice