Provider Demographics
NPI:1023153483
Name:MARION, IRENE DIANE (DDS)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:DIANE
Last Name:MARION
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WHITE PINE TER
Mailing Address - Street 2:
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-9508
Mailing Address - Country:US
Mailing Address - Phone:860-651-5620
Mailing Address - Fax:
Practice Address - Street 1:340 BROAD ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3030
Practice Address - Country:US
Practice Address - Phone:860-285-0323
Practice Address - Fax:860-285-0323
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT65181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice