Provider Demographics
NPI:1013113984
Name:ALCANTARA, MARRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARRA
Middle Name:
Last Name:ALCANTARA
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 1:558 WEST SIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304
Mailing Address - Country:US
Mailing Address - Phone:201-451-7645
Mailing Address - Fax:201-451-7647
Practice Address - Street 1:558 WEST SIDE AVENUE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304
Practice Address - Country:US
Practice Address - Phone:201-451-7645
Practice Address - Fax:201-451-7647
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023675021223G0001X
NJ22D102367505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice