Provider Demographics
NPI:1710962931
Name:MARCHENA, JOSE (DMD,MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:MARCHENA
Suffix:
Gender:M
Credentials:DMD,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ESSEX CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2905
Mailing Address - Country:US
Mailing Address - Phone:978-531-1450
Mailing Address - Fax:978-531-9984
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2910
Practice Address - Country:US
Practice Address - Phone:978-531-1450
Practice Address - Fax:978-531-9984
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA760850OtherTUFTS
MAAA69690OtherHP
MA0205273Medicaid
MAAA68463OtherHP
MAX09533OtherBS
MAAA65447OtherHP
MAV06473OtherBS
MA0205273Medicaid