Provider Demographics
NPI:1720172679
Name:DEMARCO, JOSEPH EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:DEMARCO
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 1:974 73RD ST
Mailing Address - Street 2:SUITE 37
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50312-1024
Mailing Address - Country:US
Mailing Address - Phone:515-282-0973
Mailing Address - Fax:515-288-5552
Practice Address - Street 1:974 73RD ST
Practice Address - Street 2:SUITE 37
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50312-1024
Practice Address - Country:US
Practice Address - Phone:515-282-0973
Practice Address - Fax:515-288-5552
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA76671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice