Provider Demographics
NPI:1831223833
Name:MARQUARD, STEPHEN C (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:MARQUARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 WELLINGTON CRES
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-6729
Mailing Address - Country:US
Mailing Address - Phone:507-332-2080
Mailing Address - Fax:
Practice Address - Street 1:115 DREW AVE SE
Practice Address - Street 2:STE 202
Practice Address - City:MADELIA
Practice Address - State:MN
Practice Address - Zip Code:56062-1870
Practice Address - Country:US
Practice Address - Phone:507-642-8742
Practice Address - Fax:507-642-2926
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND91491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice