Provider Demographics
NPI:1962660258
Name:MARION, LOUIS R (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:R
Last Name:MARION
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 LOCUST ST
Mailing Address - Street 2:SUITE 1416
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4329
Mailing Address - Country:US
Mailing Address - Phone:215-732-5110
Mailing Address - Fax:215-732-9938
Practice Address - Street 1:1500 LOCUST STREET
Practice Address - Street 2:SUITE 1416
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4314
Practice Address - Country:US
Practice Address - Phone:215-732-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029497L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics