Provider Demographics
NPI:1538560495
Name:MARRA, ANITA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:MARRA
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 1:1238 E CHANDLER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-4601
Mailing Address - Country:US
Mailing Address - Phone:480-460-0484
Mailing Address - Fax:480-283-8511
Practice Address - Street 1:1238 E CHANDLER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-4601
Practice Address - Country:US
Practice Address - Phone:480-460-0484
Practice Address - Fax:480-283-8511
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ 4340OtherDENTIST