Provider Demographics
NPI:1396967519
Name:MARVEGGIO, MARGO (DMD)
Entity type:Individual
Prefix:DR
First Name:MARGO
Middle Name:
Last Name:MARVEGGIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ARMONDE CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8516
Mailing Address - Country:US
Mailing Address - Phone:601-856-3663
Mailing Address - Fax:
Practice Address - Street 1:1011 MISSION 66
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-2753
Practice Address - Country:US
Practice Address - Phone:601-636-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2624-91122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist