Provider Demographics
NPI:1609021740
Name:FLACK, MARCIE AHMAN (DDS)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:AHMAN
Last Name:FLACK
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 1:8778 PARTRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80126-5261
Mailing Address - Country:US
Mailing Address - Phone:614-595-8756
Mailing Address - Fax:
Practice Address - Street 1:8906 W BOWLES AVE STE 200
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3400
Practice Address - Country:US
Practice Address - Phone:303-973-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99011223P0221X
NMDD3791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry