Provider Demographics
NPI:1679229504
Name:MARVEL DENTAL DDS PC
Entity Type:Organization
Organization Name:MARVEL DENTAL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BHAVNEET
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-666-5100
Mailing Address - Street 1:11516 PRATO CV
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1385
Mailing Address - Country:US
Mailing Address - Phone:216-801-2718
Mailing Address - Fax:
Practice Address - Street 1:6408 W JEFFERSON BLVD STE D
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6204
Practice Address - Country:US
Practice Address - Phone:216-801-2718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental