Provider Demographics
NPI:1518075977
Name:MARUSCHAK, RICHARD RONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RONALD
Last Name:MARUSCHAK
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 1:111 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1126
Mailing Address - Country:US
Mailing Address - Phone:419-732-2572
Mailing Address - Fax:419-898-0122
Practice Address - Street 1:111 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1126
Practice Address - Country:US
Practice Address - Phone:419-732-2572
Practice Address - Fax:419-898-0122
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-015934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist