Provider Demographics
NPI:1619274263
Name:BLUE, MARCUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
Last Name:BLUE
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 1:227 MIDLAND AVE
Mailing Address - Street 2:SUITE C-6
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:227 MIDLAND AVENUE
Practice Address - Street 2:SUITE C-6
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621
Practice Address - Country:US
Practice Address - Phone:970-927-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO102751223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics