Provider Demographics
NPI:1447462817
Name:MCQUEEN, MARVIN E (DDS)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:E
Last Name:MCQUEEN
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 1:407 CRUISE ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-4742
Mailing Address - Country:US
Mailing Address - Phone:662-287-9500
Mailing Address - Fax:662-287-9596
Practice Address - Street 1:407 CRUISE ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-4742
Practice Address - Country:US
Practice Address - Phone:662-287-9500
Practice Address - Fax:662-287-9596
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2834-941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660170Medicaid