Provider Demographics
NPI:1023144904
Name:MARSE, GEORGE P JR (DDS, MS, PC, FACS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:P
Last Name:MARSE
Suffix:JR
Gender:M
Credentials:DDS, MS, PC, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 TRENTON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6549
Mailing Address - Country:US
Mailing Address - Phone:504-455-5580
Mailing Address - Fax:
Practice Address - Street 1:4408 TRENTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6549
Practice Address - Country:US
Practice Address - Phone:504-455-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA28431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA721357930OtherTIN