Provider Demographics
NPI:1831393651
Name:ZEFRAN, MARISSA S (DMD)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:S
Last Name:ZEFRAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 TEXAS PALMYRA HWY
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-7675
Mailing Address - Country:US
Mailing Address - Phone:570-253-6342
Mailing Address - Fax:570-253-0989
Practice Address - Street 1:1214 TEXAS PALMYRA HWY
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-7675
Practice Address - Country:US
Practice Address - Phone:570-253-6342
Practice Address - Fax:570-253-0989
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-037209-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice