Provider Demographics
NPI:1407297898
Name:MARASCO, RICHARD JAMES JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:MARASCO
Suffix:JR
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 1:226 CANYON WOODS WAY
Mailing Address - Street 2:#B
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4512
Mailing Address - Country:US
Mailing Address - Phone:925-708-0158
Mailing Address - Fax:
Practice Address - Street 1:1111 CIVIC DR
Practice Address - Street 2:UNIT 145
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3895
Practice Address - Country:US
Practice Address - Phone:925-937-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA625721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice