Provider Demographics
NPI:1508595216
Name:MARUCA, DAVID DOUGLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DOUGLAS
Last Name:MARUCA
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 1:300 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1060
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:15931-1060
Practice Address - Country:US
Practice Address - Phone:814-472-7022
Practice Address - Fax:814-472-7832
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043436501223G0001X
PADS043650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist