Provider Demographics
NPI:1528154796
Name:MARLEY, WILLIAM JAY JR (DDS)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JAY
Last Name:MARLEY
Suffix:JR
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 1:143 E BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603
Mailing Address - Country:US
Mailing Address - Phone:907-235-9649
Mailing Address - Fax:907-235-9649
Practice Address - Street 1:4252 HOHE ST
Practice Address - Street 2:STE A
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603
Practice Address - Country:US
Practice Address - Phone:907-235-8909
Practice Address - Fax:907-235-8517
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD1413Medicaid
WADE00009027OtherWA STATE DEPT OF HEALTH