Provider Demographics
NPI:1174079461
Name:MARCUCCI, MYRNA
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:
Last Name:MARCUCCI
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:CMR 427 BOX 519
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CASERMA EDERLE BLDG 2310
Practice Address - Street 2:
Practice Address - City:VICENZA
Practice Address - State:ITALY
Practice Address - Zip Code:09630
Practice Address - Country:IT
Practice Address - Phone:39044-461-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant