Provider Demographics
NPI:1942862503
Name:FRUITHANDLER, MARC ADAM (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ADAM
Last Name:FRUITHANDLER
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WINDING HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2249
Mailing Address - Country:US
Mailing Address - Phone:214-228-6725
Mailing Address - Fax:
Practice Address - Street 1:213 NORTH MURPHY ROAD
Practice Address - Street 2:SUITE 700
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094
Practice Address - Country:US
Practice Address - Phone:972-363-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics