Provider Demographics
NPI:1356502199
Name:MARLOW FAMILY DENTAL
Entity type:Organization
Organization Name:MARLOW FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:GORECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-751-7777
Mailing Address - Street 1:1905 MARLOW DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2175
Mailing Address - Country:US
Mailing Address - Phone:586-751-7777
Mailing Address - Fax:586-751-5845
Practice Address - Street 1:1905 MARLOW DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2175
Practice Address - Country:US
Practice Address - Phone:586-751-7777
Practice Address - Fax:586-751-5845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15707122300000X
MI15604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty