Provider Demographics
NPI:1174873509
Name:POYNTER, MARQUETTA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARQUETTA
Middle Name:
Last Name:POYNTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 GAGEL AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4014
Mailing Address - Country:US
Mailing Address - Phone:502-361-1417
Mailing Address - Fax:
Practice Address - Street 1:1008 GAGEL AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4014
Practice Address - Country:US
Practice Address - Phone:502-361-1417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice