Provider Demographics
NPI:1053704155
Name:JEAN, MARCUS (DDS)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
Last Name:JEAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 BELCREST RD APT 1616D
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2010
Mailing Address - Country:US
Mailing Address - Phone:941-993-8687
Mailing Address - Fax:
Practice Address - Street 1:6515 BELCREST RD APT 1616D
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2010
Practice Address - Country:US
Practice Address - Phone:941-993-8687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program