Provider Demographics
NPI:1063567865
Name:MARQUEZ, EDUARDO (DMD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 E PLEASANT VALLEY BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-7509
Mailing Address - Country:US
Mailing Address - Phone:814-942-7686
Mailing Address - Fax:814-942-7801
Practice Address - Street 1:1913 E PLEASANT VALLEY BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-7509
Practice Address - Country:US
Practice Address - Phone:814-942-7686
Practice Address - Fax:814-942-7801
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0355431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
263892675OtherTAX ID NUMBER