Provider Demographics
NPI:1700977949
Name:MARION & MCNEIL SMILE CENTER
Entity Type:Organization
Organization Name:MARION & MCNEIL SMILE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARION
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-452-4300
Mailing Address - Street 1:111 SOUTH HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063
Mailing Address - Country:US
Mailing Address - Phone:724-452-4300
Mailing Address - Fax:
Practice Address - Street 1:111 SOUTH HIGH ST
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063
Practice Address - Country:US
Practice Address - Phone:724-452-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024737L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty