Provider Demographics
NPI:1780363556
Name:LARD, MARCUS AVERY (DMD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:AVERY
Last Name:LARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 W ARIZONA PAVILIONS DR APT 12101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-6829
Mailing Address - Country:US
Mailing Address - Phone:330-883-7545
Mailing Address - Fax:
Practice Address - Street 1:13410 E MARY ANN CLEVELAND WAY
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-8613
Practice Address - Country:US
Practice Address - Phone:520-316-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0119051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice