Provider Demographics
NPI:1336410182
Name:NORTICK, MARIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIEL
Middle Name:
Last Name:NORTICK
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 1:1350 SPRING STREET
Mailing Address - Street 2:STE 600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2870
Mailing Address - Country:US
Mailing Address - Phone:404-389-1950
Mailing Address - Fax:678-444-4152
Practice Address - Street 1:435 ARROWHEAD BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1219
Practice Address - Country:US
Practice Address - Phone:404-389-1950
Practice Address - Fax:678-444-4152
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5886122300000X
GADNO144921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist