1073806998 NPI number — CORA A MARSAW DDS PA

Table of content: (NPI 1073806998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073806998 NPI number — CORA A MARSAW DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORA A MARSAW DDS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073806998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3605 I-30 WEST
Provider Second Line Business Mailing Address:
SUITE -B
Provider Business Mailing Address City Name:
MESQUITE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-270-9647
Provider Business Mailing Address Fax Number:
972-270-9648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3605 INTERSTATE 30
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75150-2670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-270-9647
Provider Business Practice Location Address Fax Number:
972-270-9648
Provider Enumeration Date:
05/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MARSAW
Authorized Official First Name:
CORA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PERIODONTIST
Authorized Official Telephone Number:
972-270-9647

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  015805 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 646307 . This is a "DELTA CARE FACILITY ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 008994801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 405623 . This is a "UNITED CONCORDIA PROVIDER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 250578 . This is a "CIGNA FACILITY ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4001093 . This is a "GUARDIAN PROVIDER NUMBER DVILLE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0009003 . This is a "FORTTIS FACILITY ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4001092 . This is a "GUARDIAN PROVIDER NUMBER MESQUITE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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