Provider Demographics
NPI:1780797308
Name:JACK M. MARINCEL, D.D.S., P.C.
Entity type:Organization
Organization Name:JACK M. MARINCEL, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MARINCEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-846-1480
Mailing Address - Street 1:6060 TELEGRAPH RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-4762
Mailing Address - Country:US
Mailing Address - Phone:314-846-1480
Mailing Address - Fax:
Practice Address - Street 1:6060 TELEGRAPH RD
Practice Address - Street 2:SUITE H
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-4762
Practice Address - Country:US
Practice Address - Phone:314-846-1480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13331261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental