Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DR28198 | CA |
NPI | 1023038296 |
---|---|
Provider Name | Dr. John Philip Marsden |
First Address | Apple Valley, CA 92307-0000 |
Second Address | Apple Valley, CA 92307-2215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 22/12/2009 |