Provider Demographics
NPI:1699110767
Name:MARDEN, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:MARDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 CRYSTAL LAKE DR
Mailing Address - Street 2:UNIT # 76
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-1292
Mailing Address - Country:US
Mailing Address - Phone:954-303-2054
Mailing Address - Fax:
Practice Address - Street 1:4255 CRYSTAL LAKE DR
Practice Address - Street 2:UNIT # 76
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1292
Practice Address - Country:US
Practice Address - Phone:954-303-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist