Provider Demographics
NPI:1629123344
Name:MARCHESE, NIDIA P (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIDIA
Middle Name:P
Last Name:MARCHESE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1221
Mailing Address - Country:US
Mailing Address - Phone:570-346-7760
Mailing Address - Fax:570-346-9002
Practice Address - Street 1:313 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1221
Practice Address - Country:US
Practice Address - Phone:570-346-7760
Practice Address - Fax:570-346-9002
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024456L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry