Provider Demographics
NPI:1871641092
Name:MARSHAK, DAVID MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARTIN
Last Name:MARSHAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:MARTIN
Other - Last Name:MARSHAK DDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:200 S EL MOLINO AVE
Mailing Address - Street 2:#5
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2985
Mailing Address - Country:US
Mailing Address - Phone:626-796-5496
Mailing Address - Fax:626-793-8961
Practice Address - Street 1:200 S EL MOLINO AVE
Practice Address - Street 2:#5
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2985
Practice Address - Country:US
Practice Address - Phone:626-796-5496
Practice Address - Fax:626-793-8961
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA205591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics