Provider Demographics
NPI:1730754540
Name:MARKS, MARINA DANIELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:DANIELLE
Last Name:MARKS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 ELAM DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-3131
Mailing Address - Country:US
Mailing Address - Phone:502-827-9662
Mailing Address - Fax:
Practice Address - Street 1:3100 RING RD # 104
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1282
Practice Address - Country:US
Practice Address - Phone:270-982-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10617122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist