Provider Demographics
NPI:1679249452
Name:MARBACH DENTAL AND BRACES PLLC
Entity Type:Organization
Organization Name:MARBACH DENTAL AND BRACES PLLC
Other - Org Name:MARBACH DENTAL AND BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:GOLDWYN
Authorized Official - Last Name:JEQUINTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-674-4799
Mailing Address - Street 1:9107 MARBACH RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1832
Mailing Address - Country:US
Mailing Address - Phone:210-674-4799
Mailing Address - Fax:
Practice Address - Street 1:9107 MARBACH RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1832
Practice Address - Country:US
Practice Address - Phone:210-674-4799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty