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General NPI Number Information
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NPI Number | 1811108749
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Entity Type | Organization
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Legal Business Name | DEMARCO DENTAL PRACTICE,P.C.
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 974 73RD ST SUITE 37
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City | WINDSOR HEIGHTS
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State | IA
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Zip | 50312-1026
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Country | US
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Telephone | 515-282-0973
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Fax |
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Provider Business Mailing Address
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Address Line | 974 73RD ST. SUITE 37
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City | DES MOINES
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State | IA
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Zip | 50312-1026
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Country | US
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Telephone | 515-282-0973
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH EDWARD DEMARCO
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Credential | D.D.S.
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Telephone | 515-282-0973
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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 | 7667
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License Number State | IA
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