Provider Demographics
NPI:1912128604
Name:MARMOR, DEBORAH S (DMD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:MARMOR
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 1:2550 CRAWFORD AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-278-8418
Mailing Address - Fax:847-306-3588
Practice Address - Street 1:2550 CRAWFORD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-278-8418
Practice Address - Fax:847-306-3588
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190269591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice