Provider Demographics
NPI:1366549727
Name:DAY, MARIANNE R (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:R
Last Name:DAY
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 1:608 ALAMEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005
Mailing Address - Country:US
Mailing Address - Phone:575-523-5589
Mailing Address - Fax:575-527-9284
Practice Address - Street 1:608 ALAMEDA BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005
Practice Address - Country:US
Practice Address - Phone:575-523-5589
Practice Address - Fax:575-527-9284
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM14381223G0001X
NE7274122300000X
WADE00005243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist