Provider Demographics
NPI:1932238664
Name:MARISCHEN, PAUL FREDERICK (DDS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:FREDERICK
Last Name:MARISCHEN
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 1:3443 N CENTRAL AVE
Mailing Address - Street 2:STE 700
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2208
Mailing Address - Country:US
Mailing Address - Phone:602-242-2256
Mailing Address - Fax:602-242-8132
Practice Address - Street 1:3443 N CENTRAL AVE
Practice Address - Street 2:STE 700
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2208
Practice Address - Country:US
Practice Address - Phone:602-242-2256
Practice Address - Fax:602-242-8132
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31671223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
T76841Medicare UPIN