Provider Demographics
NPI:1457471724
Name:MARROQUIN, MARIO A (DDS)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:A
Last Name:MARROQUIN
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 1:17705 HALE AVE
Mailing Address - Street 2:G1
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4345
Mailing Address - Country:US
Mailing Address - Phone:408-779-3464
Mailing Address - Fax:408-787-2576
Practice Address - Street 1:17705 HALE AVE
Practice Address - Street 2:G1
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4345
Practice Address - Country:US
Practice Address - Phone:408-779-3464
Practice Address - Fax:408-787-2576
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist