Provider Demographics
NPI:1356906218
Name:MCCALL, MARJORIE FRASIER
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:FRASIER
Last Name:MCCALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 STONEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-6281
Mailing Address - Country:US
Mailing Address - Phone:865-603-8016
Mailing Address - Fax:
Practice Address - Street 1:1322 STONEBROOK LN
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-6281
Practice Address - Country:US
Practice Address - Phone:865-306-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN647124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist