Provider Demographics
NPI:1740374594
Name:MARQUEZ, JOSE ANTONIO (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8327 VERDELAND DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-3822
Mailing Address - Country:US
Mailing Address - Phone:915-594-9004
Mailing Address - Fax:
Practice Address - Street 1:11601 PELLICANO DR
Practice Address - Street 2:SUITE A-4
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6279
Practice Address - Country:US
Practice Address - Phone:915-594-4048
Practice Address - Fax:915-594-9854
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
TX104271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice