Provider Demographics
NPI:1215083001
Name:ROBERT J. DEMARCO,D.M.D.,P.C.
Entity type:Organization
Organization Name:ROBERT J. DEMARCO,D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-566-6478
Mailing Address - Street 1:8877 W UNION HILLS DR
Mailing Address - Street 2:600
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3008
Mailing Address - Country:US
Mailing Address - Phone:623-566-7241
Mailing Address - Fax:
Practice Address - Street 1:8877 W UNION HILLS DR
Practice Address - Street 2:600
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3008
Practice Address - Country:US
Practice Address - Phone:623-566-6478
Practice Address - Fax:623-566-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ-D39861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty