Provider Demographics
NPI:1982764122
Name:MARQUIS, GEORGE JOSEPH (DMD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JOSEPH
Last Name:MARQUIS
Suffix:
Gender:M
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:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-0429
Mailing Address - Country:US
Mailing Address - Phone:662-862-7434
Mailing Address - Fax:662-862-7434
Practice Address - Street 1:6 MEDICAL PARK DR.
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-0429
Practice Address - Country:US
Practice Address - Phone:662-862-7434
Practice Address - Fax:662-862-7434
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1910-801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice