Provider Demographics
NPI:1679662902
Name:DICKER, MARSHALL S (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:S
Last Name:DICKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2032
Mailing Address - Country:US
Mailing Address - Phone:917-446-4731
Mailing Address - Fax:973-669-0136
Practice Address - Street 1:3592 JFK BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307
Practice Address - Country:US
Practice Address - Phone:917-446-4731
Practice Address - Fax:973-669-0136
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0397981223G0001X
NJ22DI010569001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice