Provider Demographics
NPI:1609121599
Name:RASMUSSEN, MARC A (DDS)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 SISKIYOU BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8197
Mailing Address - Country:US
Mailing Address - Phone:541-779-3324
Mailing Address - Fax:
Practice Address - Street 1:2924 SISKIYOU BLVD STE 204
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8197
Practice Address - Country:US
Practice Address - Phone:541-779-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10871223E0200X
TX322331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics