Provider Demographics
NPI:1003090416
Name:MARUCA, ROBERT REGIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:REGIS
Last Name:MARUCA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931
Mailing Address - Country:US
Mailing Address - Phone:814-472-7022
Mailing Address - Fax:814-472-7832
Practice Address - Street 1:300 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931
Practice Address - Country:US
Practice Address - Phone:814-472-7022
Practice Address - Fax:814-472-7832
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist