Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist |
NPI | 1699110767 |
---|---|
Provider Name | Scott Marden |
First Address | Pompano Beach, FL 33064-1292 |
Second Address | Pompano Beach, FL 33064-1292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2013 |
Last Update Date | 02/05/2013 |