Provider Demographics
NPI:1568953073
Name:MARVILL DENTAL, PLLC
Entity Type:Organization
Organization Name:MARVILL DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:F
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-475-3995
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-0310
Mailing Address - Country:US
Mailing Address - Phone:972-475-3995
Mailing Address - Fax:972-463-4298
Practice Address - Street 1:3613 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-5003
Practice Address - Country:US
Practice Address - Phone:972-475-3995
Practice Address - Fax:972-463-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29952261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306251756OtherINDIVIDUAL NPI