Provider Demographics
NPI:1568676682
Name:MARQUEZ DENTAL INC
Entity Type:Organization
Organization Name:MARQUEZ DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-423-6116
Mailing Address - Street 1:2638 MAIN ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-4623
Mailing Address - Country:US
Mailing Address - Phone:619-423-6116
Mailing Address - Fax:619-423-6149
Practice Address - Street 1:2638 MAIN ST
Practice Address - Street 2:SUITE J
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4623
Practice Address - Country:US
Practice Address - Phone:619-423-6116
Practice Address - Fax:619-423-6149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA387161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3871601OtherDENTICAL