Provider Demographics
NPI:1679623953
Name:MOSCOWITZ, MARC I (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:I
Last Name:MOSCOWITZ
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 1:731 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2514
Mailing Address - Country:US
Mailing Address - Phone:973-743-5116
Mailing Address - Fax:973-743-4640
Practice Address - Street 1:731 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2514
Practice Address - Country:US
Practice Address - Phone:973-743-5116
Practice Address - Fax:973-743-4640
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ170381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice