MEDICARE: MR. PAUL FREDERICK MARISCHEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	3167	AZ

General Provider Information

NPI Number	:	1932238664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL FREDERICK MARISCHEN DDS

Provider Business Mailing Address
First Line	:	3443 N CENTRAL AVE
Second Line	:	STE 700
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2208
Country	:	US
Telephone Number	:	602-242-2256
Fax Number	:	602-242-8132

Provider Business Practice Location Address
First Line	:	3443 N CENTRAL AVE
Second Line	:	STE 700
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2208
Country	:	US
Telephone Number	:	602-242-2256
Fax Number	:	602-242-8132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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