Provider Demographics
NPI:1629204748
Name:SEAN A. MARFIA D.M.D., P.C.
Entity type:Organization
Organization Name:SEAN A. MARFIA D.M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-358-9700
Mailing Address - Street 1:249 W DUNDEE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-2699
Mailing Address - Country:US
Mailing Address - Phone:847-358-9700
Mailing Address - Fax:847-358-9705
Practice Address - Street 1:249 W DUNDEE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-2699
Practice Address - Country:US
Practice Address - Phone:847-358-9700
Practice Address - Fax:847-358-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190259501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9184143Medicaid
IL1871563148OtherINDIVIDUAL NPI