Basic Information
| Provider Information | |||||||||
| NPI: | 1265467518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1844 SAN MIGUEL DR STE 209 | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945964913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259376350 | ||||||||
| FaxNumber: | 9259376352 | ||||||||
| Practice Location | |||||||||
| Address1: | 1844 SAN MIGUEL DR STE 209 | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945964913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259376350 | ||||||||
| FaxNumber: | 9259376352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0300X | D19647 | CA | Y | Dental Providers | Dentist | Periodontics |
No ID Information.