Provider Demographics
NPI:1518187632
Name:MARSH, PAUL JON (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JON
Last Name:MARSH
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 1:16 ASHLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1622
Mailing Address - Country:US
Mailing Address - Phone:845-354-9524
Mailing Address - Fax:
Practice Address - Street 1:505 CLAREMONT PARKWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-299-3600
Practice Address - Fax:718-901-3543
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0279491122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00500803Medicaid