Provider Demographics
NPI:1962868802
Name:MARPLE DENTAL, INC.
Entity type:Organization
Organization Name:MARPLE DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGES
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-359-8181
Mailing Address - Street 1:2004 SPROUL RD
Mailing Address - Street 2:STE 304
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3511
Mailing Address - Country:US
Mailing Address - Phone:610-359-8181
Mailing Address - Fax:610-359-8111
Practice Address - Street 1:2004 SPROUL RD
Practice Address - Street 2:STE 304
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3511
Practice Address - Country:US
Practice Address - Phone:610-359-8181
Practice Address - Fax:610-359-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-025838 L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty