1285892174 NPI number — DR. KENNETH REID MARSH DDS

Table of content: DR. KENNETH REID MARSH DDS (NPI 1285892174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285892174 NPI number — DR. KENNETH REID MARSH DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSH
Provider First Name:
KENNETH
Provider Middle Name:
REID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285892174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 596
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CREEDMOOR
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27522-0596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-528-8610
Provider Business Mailing Address Fax Number:
919-528-8610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1582 HWY 56
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CREEDMOOR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-528-1980
Provider Business Practice Location Address Fax Number:
919-528-8610
Provider Enumeration Date:
05/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  8579 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5909754 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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