Provider Demographics
NPI:1831303304
Name:MARCUS, ALAN DAVID
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DAVID
Last Name:MARCUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 BROADWAY
Mailing Address - Street 2:STE 500
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030
Mailing Address - Country:US
Mailing Address - Phone:650-692-7933
Mailing Address - Fax:650-692-7950
Practice Address - Street 1:485 BROADWAY
Practice Address - Street 2:STE 500
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030
Practice Address - Country:US
Practice Address - Phone:650-692-7933
Practice Address - Fax:650-692-7950
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics