Provider Demographics
NPI:1447379995
Name:MARION, DAVID P (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:MARION
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 1:629 BEAVER RUIN RD NW STE A
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3437
Mailing Address - Country:US
Mailing Address - Phone:770-279-8800
Mailing Address - Fax:
Practice Address - Street 1:629 BEAVER RUIN RD NW STE A
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3437
Practice Address - Country:US
Practice Address - Phone:770-279-8800
Practice Address - Fax:770-931-9775
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice