Provider Demographics
NPI:1952461808
Name:MAR, RODERICK SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:SCOTT
Last Name:MAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RODERICK
Other - Middle Name:S
Other - Last Name:MAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3049 BEACON AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144
Mailing Address - Country:US
Mailing Address - Phone:206-328-3100
Mailing Address - Fax:206-860-4265
Practice Address - Street 1:3049 BEACON AVE SOUTH
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144
Practice Address - Country:US
Practice Address - Phone:206-328-3100
Practice Address - Fax:206-860-4265
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist