Provider Demographics
NPI:1427593987
Name:MCCOMB, MARILYN (DDS)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:MCCOMB
Suffix:
Gender:F
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:PO BOX 60036
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89006-0036
Mailing Address - Country:US
Mailing Address - Phone:702-765-0041
Mailing Address - Fax:702-800-5441
Practice Address - Street 1:1022 NEVADA HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-1825
Practice Address - Country:US
Practice Address - Phone:702-580-4509
Practice Address - Fax:702-800-5441
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-35C1223P0221X
DC51661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry