Provider Demographics
NPI:1811907744
Name:NEFF, MARCUS D (DDS)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:D
Last Name:NEFF
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 1:1000 N 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5757
Mailing Address - Country:US
Mailing Address - Phone:208-232-3368
Mailing Address - Fax:208-776-5016
Practice Address - Street 1:1000 N 8TH AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5757
Practice Address - Country:US
Practice Address - Phone:208-232-3368
Practice Address - Fax:208-776-5016
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD37101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1952316341OtherNPI FOR BUSINESS
ID806687200Medicaid