MEDICARE: EDUARDO MARQUEZ D.M.D.

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	1223G0001X	General Practice Dentistry	DS035543	PA

General Provider Information

NPI Number	:	1063567865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO MARQUEZ D.M.D.

Provider Business Mailing Address
First Line	:	1913 E PLEASANT VALLEY BLVD
Second Line	:	SUITE #3
City	:	ALTOONA
State	:	PA
Zip	:	16602-7509
Country	:	US
Telephone Number	:	814-942-7686
Fax Number	:	814-942-7801

Provider Business Practice Location Address
First Line	:	1913 E PLEASANT VALLEY BLVD
Second Line	:	SUITE #3
City	:	ALTOONA
State	:	PA
Zip	:	16602-7509
Country	:	US
Telephone Number	:	814-942-7686
Fax Number	:	814-942-7801

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	12/22/2008

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