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General NPI Number Information
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NPI Number | 1588833677
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Entity Type | Individual
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Provider Name | EDUARDO MARCUSCHAMER DDS
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Gender | Male
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 07/18/2013
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Provider Practice Location Address
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Address Line | SEMINARIO164 LOMAS DE LA HERRADURA
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City | MEXICO
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State | MEXICO
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Zip | 52785
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Country | MX
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Telephone | 617-821-9885
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Fax |
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Provider Business Mailing Address
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Address Line | 265 C ST APT 2
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City | SOUTH BOSTON
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State | MA
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Zip | 02127-1916
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Country | US
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Telephone | 617-821-9885
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | 26475
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 00202029
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License Number State | CO
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