Provider Demographics
NPI:1821779786
Name:MARWAN AL, PLLC
Entity Type:Organization
Organization Name:MARWAN AL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OPENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-239-9254
Mailing Address - Street 1:4451 AUTUMN SAGE DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-1285
Mailing Address - Country:US
Mailing Address - Phone:385-239-9254
Mailing Address - Fax:682-626-1824
Practice Address - Street 1:200 BEAUCHAMP STE 104
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-9156
Practice Address - Country:US
Practice Address - Phone:972-736-6226
Practice Address - Fax:972-736-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty