Provider Demographics
NPI:1154365161
Name:AUERBACH, MARC ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANDREW
Last Name:AUERBACH
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 1:2402 E CERRADA DE PROMESA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3031
Mailing Address - Country:US
Mailing Address - Phone:520-529-5727
Mailing Address - Fax:
Practice Address - Street 1:2402 E CERRADA DE PROMESA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-3031
Practice Address - Country:US
Practice Address - Phone:520-529-5727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD030321223P0221X
TX253711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ085549OtherAHCCCS PROVIDER NUMBER