Provider Demographics
NPI:1720583487
Name:PLAISANCE, MARC CHARLES JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:CHARLES
Last Name:PLAISANCE
Suffix:JR
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 1:6369 CHERRY TREE LN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3314
Mailing Address - Country:US
Mailing Address - Phone:678-232-9573
Mailing Address - Fax:
Practice Address - Street 1:2751 BUFORD HWY NE STE 302
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5456
Practice Address - Country:US
Practice Address - Phone:404-634-1277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0156611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice