Healthcare Provider Details

I. General information

NPI: 1952896334
Provider Name (Legal Business Name): DANIEL MARICHE-POIROT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 CHESTNUT ST FL 4
PHILADELPHIA PA
19107-4131
US

IV. Provider business mailing address

1233 LOCUST ST FL 3
PHILADELPHIA PA
19107-5400
US

V. Phone/Fax

Practice location:
  • Phone: 215-525-3046
  • Fax:
Mailing address:
  • Phone: 215-985-4448
  • Fax: 215-732-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS042302
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: