Provider Demographics
NPI:1497343685
Name:MARCO A TAUIL DDS, PC
Entity Type:Organization
Organization Name:MARCO A TAUIL DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:OXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-403-9256
Mailing Address - Street 1:2340 S COMMERCE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-2174
Mailing Address - Country:US
Mailing Address - Phone:248-624-0676
Mailing Address - Fax:
Practice Address - Street 1:2340 S COMMERCE RD STE 1
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-2174
Practice Address - Country:US
Practice Address - Phone:248-624-0676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty