Individual
STEVEN J MARCELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
156 W MAIN ST, THIBODAUX, LA 70301-5216
(985) 446-3754
(985) 449-1582
Mailing address
156 W MAIN ST, THIBODAUX, LA 70301-5216
(985) 446-3754
(985) 449-1582
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3570
LA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
3570
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174753321
—
LA
05
—
1275680944
—
LA
Enumeration date
01/04/2007
Last updated
11/03/2011
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