Provider Demographics
NPI:1215146626
Name:MARUCA, ANITA MARIA
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:MARIA
Last Name:MARUCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10159 CAMPGROUND RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:GA
Mailing Address - Zip Code:30818-1729
Mailing Address - Country:US
Mailing Address - Phone:706-547-9372
Mailing Address - Fax:
Practice Address - Street 1:1446 HARPER ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0012
Practice Address - Country:US
Practice Address - Phone:706-721-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant