Provider Demographics
NPI:1831280908
Name:MARCUZ, PAUL ERNEST (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ERNEST
Last Name:MARCUZ
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 1:18223 E 10 MILE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-5821
Mailing Address - Country:US
Mailing Address - Phone:586-775-0520
Mailing Address - Fax:586-775-2670
Practice Address - Street 1:18223 E 10 MILE RD STE 300
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5821
Practice Address - Country:US
Practice Address - Phone:586-775-0520
Practice Address - Fax:586-775-2670
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010159341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0002091OtherFORTIS ID NUMBER
MA3375692Medicaid
MI001371874OtherUNITED CONCORDIA ID #
MI053109OtherFIRST COMMONWEATH ID #