Provider Demographics
NPI:1457441255
Name:MARCHAND, SAMUEL B SUAREZ (DM)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:B SUAREZ
Last Name:MARCHAND
Suffix:
Gender:M
Credentials:DM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4006
Mailing Address - Street 2:BAYAMON GARDENS STATION
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-1006
Mailing Address - Country:US
Mailing Address - Phone:787-787-0078
Mailing Address - Fax:
Practice Address - Street 1:AVE. BETANCES H 56
Practice Address - Street 2:HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-787-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist