Provider Demographics
NPI:1245333756
Name:DEMARCO, JOHN M (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:DEMARCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:M
Other - Last Name:DEMARCO DDS INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:740-296-4965
Mailing Address - Fax:239-278-3857
Practice Address - Street 1:4300 KINGS HWY
Practice Address - Street 2:#500
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2917
Practice Address - Country:US
Practice Address - Phone:239-344-2337
Practice Address - Fax:941-629-2365
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300140591223G0001X
FLHAD461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005587200Medicaid
OH0248637Medicaid