Individual
MARLI LEIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3658 S EAST ST, INDIANAPOLIS, IN 46227-1239
(317) 614-0889
Mailing address
1239 DR MARTIN LUTHER KING JR ST, INDIANAPOLIS, IN 46202-2222
(920) 246-3688
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12012737A
IN
Other
Enumeration date
06/09/2017
Last updated
06/09/2017
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