Provider Demographics
NPI:1811329956
Name:MARCKAREN, INC
Entity type:Organization
Organization Name:MARCKAREN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:COLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-782-9544
Mailing Address - Street 1:PO BOX 13167
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84412-3167
Mailing Address - Country:US
Mailing Address - Phone:801-782-9544
Mailing Address - Fax:801-786-0557
Practice Address - Street 1:2251 N 400 E
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7210
Practice Address - Country:US
Practice Address - Phone:801-782-9544
Practice Address - Fax:801-786-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9314390799221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528866301007Medicaid