Provider Demographics
NPI:1316145147
Name:MARCUS, DENA TOBY (DDS)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:TOBY
Last Name:MARCUS
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 1:644 3RD ST W
Mailing Address - Street 2:SUITE A
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6861
Mailing Address - Country:US
Mailing Address - Phone:707-996-7775
Mailing Address - Fax:707-996-0233
Practice Address - Street 1:644 3RD ST W
Practice Address - Street 2:SUITE A
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6861
Practice Address - Country:US
Practice Address - Phone:707-996-7775
Practice Address - Fax:707-996-0233
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist