Provider Demographics
NPI:1205081551
Name:MARQUEZ, ALEJANDRO R (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:R
Last Name:MARQUEZ
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 1:5007 CORVAIR ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5316
Mailing Address - Country:US
Mailing Address - Phone:917-318-9947
Mailing Address - Fax:
Practice Address - Street 1:1523 E MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-5607
Practice Address - Country:US
Practice Address - Phone:209-952-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-27
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0538081122300000X
CADDS55709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist