Provider Demographics
NPI:1427167212
Name:MAROSY, DIANE (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:MAROSY
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 1:400 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953
Mailing Address - Country:US
Mailing Address - Phone:479-394-7800
Mailing Address - Fax:479-394-7803
Practice Address - Street 1:400 PINE AVE
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953
Practice Address - Country:US
Practice Address - Phone:479-394-7800
Practice Address - Fax:479-394-7803
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR6942560001Medicare NSC