Provider Demographics
NPI:1790812279
Name:MARQUIS DENTAL CENTER
Entity Type:Organization
Organization Name:MARQUIS DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARQUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-862-7434
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-0429
Mailing Address - Country:US
Mailing Address - Phone:662-862-7434
Mailing Address - Fax:
Practice Address - Street 1:6 MEDICAL PARK DR.
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843
Practice Address - Country:US
Practice Address - Phone:662-862-7434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1910-80122300000X, 1223D0001X
MS1984-82122300000X, 1223D0001X, 1223G0001X
MS1980-801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty