Provider Demographics
NPI:1053110494
Name:MARBELLA DENTAL STUDIO
Entity type:Organization
Organization Name:MARBELLA DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-202-3250
Mailing Address - Street 1:4845 E THUNDERBIRD RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3539
Mailing Address - Country:US
Mailing Address - Phone:602-996-1660
Mailing Address - Fax:602-996-2321
Practice Address - Street 1:4845 E THUNDERBIRD RD STE 3
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3539
Practice Address - Country:US
Practice Address - Phone:602-996-1660
Practice Address - Fax:602-996-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental