Provider Demographics
NPI:1043417934
Name:MARRECAU, TOMAS PAUL (DMD)
Entity Type:Individual
Prefix:
First Name:TOMAS
Middle Name:PAUL
Last Name:MARRECAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16400 S POST RD
Mailing Address - Street 2:APT 204
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3580
Mailing Address - Country:US
Mailing Address - Phone:954-253-5336
Mailing Address - Fax:
Practice Address - Street 1:5323 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2100
Practice Address - Country:US
Practice Address - Phone:305-556-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 182301223X0400X
NJ22D1022667001223X0400X
PADS031546L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics