Provider Demographics
NPI:1255346565
Name:MARCUS, HAROLD H (DDS)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:H
Last Name:MARCUS
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 1:7215 W PASSYUNK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19142
Mailing Address - Country:US
Mailing Address - Phone:215-727-1800
Mailing Address - Fax:215-365-1493
Practice Address - Street 1:7215 W PASSYUNK AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19142
Practice Address - Country:US
Practice Address - Phone:215-727-1800
Practice Address - Fax:215-365-1493
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS14297L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0052646102Medicaid