Provider Demographics
NPI:1427420215
Name:STROMBERG, MARVIN LEIF (DDS)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:LEIF
Last Name:STROMBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 WHITEHALL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-2756
Mailing Address - Country:US
Mailing Address - Phone:214-358-4998
Mailing Address - Fax:
Practice Address - Street 1:1800 S PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-2800
Practice Address - Country:US
Practice Address - Phone:903-569-5569
Practice Address - Fax:903-569-1601
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice