Provider Demographics
NPI:1205944733
Name:P JOHN MARCUCCI DDS PC
Entity type:Organization
Organization Name:P JOHN MARCUCCI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MARCUCCI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-697-2440
Mailing Address - Street 1:556 NORTH HARDING HIGHWAY
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 NORTH HARDING HIGHWAY
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020230L122300000X
NJDI01342700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty