Provider Demographics
NPI:1144303363
Name:PRESTON, MARCIA L (DDS)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:L
Last Name:PRESTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 EAST ELM
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738
Mailing Address - Country:US
Mailing Address - Phone:417-732-7874
Mailing Address - Fax:417-732-5084
Practice Address - Street 1:604 EAST ELM
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738
Practice Address - Country:US
Practice Address - Phone:417-732-7874
Practice Address - Fax:417-732-5084
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020111861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice