Provider Demographics
NPI:1790763639
Name:MARLER, DONALD IRVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:IRVIN
Last Name:MARLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DON
Other - Middle Name:
Other - Last Name:MARLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 4071
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-0071
Mailing Address - Country:US
Mailing Address - Phone:316-832-0141
Mailing Address - Fax:316-832-0142
Practice Address - Street 1:2563 N HOOD AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67204-5736
Practice Address - Country:US
Practice Address - Phone:316-832-0141
Practice Address - Fax:316-832-0142
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS7846OtherBLUE CROSS BLUE SHIELD #
KS4481OtherSTATE LICENSE