Provider Demographics
NPI:1134461015
Name:MARCUCCI, PAUL JOHN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOHN
Last Name:MARCUCCI
Suffix:JR
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 1:556 N HARDING HWY
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-8713
Mailing Address - Country:US
Mailing Address - Phone:856-697-2440
Mailing Address - Fax:856-697-3770
Practice Address - Street 1:556 N HARDING HWY
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8713
Practice Address - Country:US
Practice Address - Phone:856-697-2440
Practice Address - Fax:856-697-3770
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO13427001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice