Provider Demographics
NPI:1912109315
Name:TARTER, MARCIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:
Last Name:TARTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11913 BLUE HAVEN CT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-1077
Mailing Address - Country:US
Mailing Address - Phone:405-773-8055
Mailing Address - Fax:
Practice Address - Street 1:500 N FINANCIAL TER
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4437
Practice Address - Country:US
Practice Address - Phone:405-376-2072
Practice Address - Fax:405-376-2094
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice