Provider Demographics
NPI:1215158142
Name:PUKENAS, MARC JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:JOSEPH
Last Name:PUKENAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 ENGLISH CREEK AVE
Mailing Address - Street 2:SUITE #304
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-9708
Mailing Address - Country:US
Mailing Address - Phone:609-645-1900
Mailing Address - Fax:609-645-8441
Practice Address - Street 1:3069 ENGLISH CREEK AVE
Practice Address - Street 2:SUITE #304
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9708
Practice Address - Country:US
Practice Address - Phone:609-645-1900
Practice Address - Fax:609-645-8441
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 02299000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist