Provider Demographics
NPI:1508243932
Name:MARQUEZ, SHIRLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:MARQUEZ
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 1:7762 GARDNER DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2610
Mailing Address - Country:US
Mailing Address - Phone:305-302-2352
Mailing Address - Fax:
Practice Address - Street 1:8951 BONITA BEACH RD SE STE 206
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4202
Practice Address - Country:US
Practice Address - Phone:239-992-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist