Provider Demographics
NPI:1487858106
Name:MARCKS, KURT OTTO (DDS)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:OTTO
Last Name:MARCKS
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 1:24099 POSTAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-7709
Mailing Address - Country:US
Mailing Address - Phone:951-601-1290
Mailing Address - Fax:951-601-1292
Practice Address - Street 1:24099 POSTAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-7709
Practice Address - Country:US
Practice Address - Phone:951-601-1290
Practice Address - Fax:951-601-1292
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics