Provider Demographics
NPI:1184079410
Name:PHILIP G. MARAIS, DDS
Entity type:Organization
Organization Name:PHILIP G. MARAIS, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:MARAIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-320-1471
Mailing Address - Street 1:1270 SARTORI AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2717
Mailing Address - Country:US
Mailing Address - Phone:310-320-1471
Mailing Address - Fax:310-320-7645
Practice Address - Street 1:1270 SARTORI AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2717
Practice Address - Country:US
Practice Address - Phone:310-320-1471
Practice Address - Fax:310-320-7645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-23
Last Update Date:2016-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27333122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA122300000XOtherTAXONOMY NUMBER
CA1851715924OtherNPI NUMBER