Provider Demographics
NPI:1437590775
Name:BISSELL, MARANDA (DDS)
Entity Type:Individual
Prefix:
First Name:MARANDA
Middle Name:
Last Name:BISSELL
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 1:475 N WALNUT ST
Mailing Address - Street 2:P.O. BOX 155
Mailing Address - City:COLFAX
Mailing Address - State:IA
Mailing Address - Zip Code:50054-9600
Mailing Address - Country:US
Mailing Address - Phone:515-674-4466
Mailing Address - Fax:515-674-3123
Practice Address - Street 1:475 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:IA
Practice Address - Zip Code:50054-9600
Practice Address - Country:US
Practice Address - Phone:515-674-4466
Practice Address - Fax:515-674-3123
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice