Provider Demographics
NPI:1902112220
Name:CRUSE, MARIANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:
Last Name:CRUSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:MARIANNE
Other - Middle Name:CRUSE
Other - Last Name:STRONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-0457
Mailing Address - Country:US
Mailing Address - Phone:318-372-7825
Mailing Address - Fax:
Practice Address - Street 1:516 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-2538
Practice Address - Country:US
Practice Address - Phone:318-372-7825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA39421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice