Provider Demographics
NPI:1609061233
Name:MARCIA L. PRESTON DDS PC PRESTON FAMILY DENTAL
Entity Type:Organization
Organization Name:MARCIA L. PRESTON DDS PC PRESTON FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-732-7874
Mailing Address - Street 1:604 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1552
Mailing Address - Country:US
Mailing Address - Phone:417-732-7874
Mailing Address - Fax:417-732-5084
Practice Address - Street 1:604 E ELM ST
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1552
Practice Address - Country:US
Practice Address - Phone:417-732-7874
Practice Address - Fax:417-732-5084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002011186261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental