Provider Demographics
NPI:1073790200
Name:PAUL E MARCUZ D.D.S.,P.C.
Entity Type:Organization
Organization Name:PAUL E MARCUZ D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-775-0520
Mailing Address - Street 1:22770 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2009
Mailing Address - Country:US
Mailing Address - Phone:586-775-0520
Mailing Address - Fax:586-775-2670
Practice Address - Street 1:22770 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2009
Practice Address - Country:US
Practice Address - Phone:586-775-0520
Practice Address - Fax:586-775-2670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0159341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0002091OtherASSURANT
MI053109OtherFIRST COMMONWEALTH
MI3375692Medicaid