Provider Demographics
NPI:1295038099
Name:J.A. MARQUEZ, DDS, PA
Entity type:Organization
Organization Name:J.A. MARQUEZ, DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:915-594-4048
Mailing Address - Street 1:11601 PELLIGANO
Mailing Address - Street 2:STE A-A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6054
Mailing Address - Country:US
Mailing Address - Phone:915-594-4048
Mailing Address - Fax:915-594-9854
Practice Address - Street 1:11601 PELLIGANO
Practice Address - Street 2:STE A-A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6054
Practice Address - Country:US
Practice Address - Phone:915-594-4048
Practice Address - Fax:915-594-9854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J.A. MARQUEZ, DDS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty