Provider Demographics
NPI:1699012047
Name:M.G. MARQUEZ, DMD,MSD,PC.
Entity Type:Organization
Organization Name:M.G. MARQUEZ, DMD,MSD,PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:GABRIELA
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MSD
Authorized Official - Phone:978-443-8814
Mailing Address - Street 1:57 CODJER LN
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2302
Mailing Address - Country:US
Mailing Address - Phone:978-443-8814
Mailing Address - Fax:978-440-8514
Practice Address - Street 1:57 CODJER LN
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2302
Practice Address - Country:US
Practice Address - Phone:978-443-8814
Practice Address - Fax:978-440-8514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty