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General NPI Number Information
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NPI Number | 1508595216
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Entity Type | Individual
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Provider Name | DAVID DOUGLAS MARUCA DMD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 300 W HIGHLAND AVE
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City | EBENSBURG
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State | PA
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Zip | 15931-1060
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Country | US
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Telephone | 814-472-7022
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Fax | 814-472-7832
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Provider Business Mailing Address
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Address Line | 300 W HIGHLAND AVE
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City | EBENSBURG
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State | PA
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Zip | 15931-1060
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Country | US
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Telephone | 814-472-7022
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Fax | 814-472-7832
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS04343650
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS043650
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License Number State | PA
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