Provider Demographics
NPI:1619975885
Name:MARRON, BRUCE OWEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:OWEN
Last Name:MARRON
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 1:321 E PLATTE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3139
Mailing Address - Country:US
Mailing Address - Phone:970-867-9700
Mailing Address - Fax:970-867-8412
Practice Address - Street 1:321 E PLATTE AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3139
Practice Address - Country:US
Practice Address - Phone:970-867-9700
Practice Address - Fax:970-867-8412
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
CO104332122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist