Provider Demographics
NPI:1588833677
Name:MARCUSCHAMER, EDUARDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:MARCUSCHAMER
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 1:265 C ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1916
Mailing Address - Country:US
Mailing Address - Phone:617-821-9885
Mailing Address - Fax:
Practice Address - Street 1:SEMINARIO164
Practice Address - Street 2:LOMAS DE LA HERRADURA
Practice Address - City:MEXICO
Practice Address - State:MEXICO
Practice Address - Zip Code:52785
Practice Address - Country:MX
Practice Address - Phone:617-821-9885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX26475122300000X
CO00202029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program