Provider Demographics
NPI:1598371718
Name:RI MAROON DENTAL GROUP PC
Entity Type:Organization
Organization Name:RI MAROON DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MAROON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-947-0394
Mailing Address - Street 1:1339 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-4302
Mailing Address - Country:US
Mailing Address - Phone:619-426-2040
Mailing Address - Fax:619-863-0251
Practice Address - Street 1:1339 THIRD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4302
Practice Address - Country:US
Practice Address - Phone:619-426-2040
Practice Address - Fax:619-863-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty