Provider Demographics
NPI:1780946558
Name:MARQUES, ANTONIO J (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:J
Last Name:MARQUES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WALNUT ST.
Mailing Address - Street 2:APT. 4A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4889
Mailing Address - Country:US
Mailing Address - Phone:787-543-9321
Mailing Address - Fax:
Practice Address - Street 1:951 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-2967
Practice Address - Country:US
Practice Address - Phone:718-860-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122300000122300000X
PADS0413611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist