Provider Demographics
NPI:1386933760
Name:MARCEL DENTAL AND ANESTHESIA SERVICES, PPLC
Entity type:Organization
Organization Name:MARCEL DENTAL AND ANESTHESIA SERVICES, PPLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MARCEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDO
Authorized Official - Phone:817-264-7899
Mailing Address - Street 1:6100 CAMP BOWIE BLVD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5528
Mailing Address - Country:US
Mailing Address - Phone:817-264-7899
Mailing Address - Fax:682-224-8559
Practice Address - Street 1:6100 CAMP BOWIE BLVD
Practice Address - Street 2:SUITE 22
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5528
Practice Address - Country:US
Practice Address - Phone:817-264-7899
Practice Address - Fax:682-224-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty