Provider Demographics
NPI:1932583705
Name:FOOTE, MARLON DAVID ANTHONY (DDS)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:DAVID ANTHONY
Last Name:FOOTE
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 1:7319 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-6746
Mailing Address - Country:US
Mailing Address - Phone:407-294-9200
Mailing Address - Fax:407-294-1577
Practice Address - Street 1:7319 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818
Practice Address - Country:US
Practice Address - Phone:407-294-9200
Practice Address - Fax:407-294-1577
Is Sole Proprietor?:No
Enumeration Date:2015-07-12
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN210761223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics