Provider Demographics
NPI:1548445646
Name:KENNETH R MARSH DDS PA
Entity type:Organization
Organization Name:KENNETH R MARSH DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-528-1980
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-0596
Mailing Address - Country:US
Mailing Address - Phone:919-528-1980
Mailing Address - Fax:919-528-8610
Practice Address - Street 1:1582 HWY 56
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522
Practice Address - Country:US
Practice Address - Phone:919-528-1980
Practice Address - Fax:919-528-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3874122300000X
NC8579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty