Provider Demographics
NPI:1356606230
Name:MARR, MICHAEL S II (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:MARR
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WESNER LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-8023
Mailing Address - Country:US
Mailing Address - Phone:570-275-2684
Mailing Address - Fax:
Practice Address - Street 1:2723 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-3158
Practice Address - Country:US
Practice Address - Phone:570-777-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist