Provider Demographics
NPI:1821227018
Name:STROUBE, MARISSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:STROUBE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 COMMONS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6349
Mailing Address - Country:US
Mailing Address - Phone:615-230-6611
Mailing Address - Fax:615-230-6614
Practice Address - Street 1:608 COMMONS DR
Practice Address - Street 2:SUITE B
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6349
Practice Address - Country:US
Practice Address - Phone:615-230-6611
Practice Address - Fax:615-230-6614
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN90111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice