Basic Information
| Provider Information | |||||||||
| NPI: | 1124267000 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARLIND STILES PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9772 W YEARLING RD | ||||||||
| Address2: | STE # A1600 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853831380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804910739 | ||||||||
| FaxNumber: | 4807771345 | ||||||||
| Practice Location | |||||||||
| Address1: | 9772 W YEARLING RD | ||||||||
| Address2: | STE # A1600 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853831380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804910739 | ||||||||
| FaxNumber: | 4807771345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2009 | ||||||||
| LastUpdateDate: | 01/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | STILES | ||||||||
| AuthorizedOfficialFirstName: | MARLIND | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4804910739 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D6957 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | Z129129 | 01 | AZ | MEDICARE PTAN | OTHER |