Provider Demographics
NPI:1750810545
Name:MARR, ANNA REBECCA (MS, DDS)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:REBECCA
Last Name:MARR
Suffix:
Gender:F
Credentials:MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-1045
Mailing Address - Country:US
Mailing Address - Phone:260-570-5524
Mailing Address - Fax:
Practice Address - Street 1:1100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-1240
Practice Address - Country:US
Practice Address - Phone:260-925-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012744A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist