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General NPI Number Information
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NPI Number | 1558345983
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Entity Type | Organization
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Legal Business Name | MARTIN TYRRELL WASHINGTON DISTRICT HEALTH DEPT
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 198 NC HIGHWAY 45 N
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City | PLYMOUTH
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State | NC
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Zip | 27962-9232
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Country | US
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Telephone | 252-793-3023
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Fax | 252-791-3159
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Provider Business Mailing Address
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Address Line | 198 NC HIGHWAY 45 N
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City | PLYMOUTH
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State | NC
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Zip | 27962-9232
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Country | US
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Telephone | 252-793-3023
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Fax | 252-791-3159
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT II
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Name | RONDA B PHELPS
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Credential |
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Telephone | 252-793-3023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | NC
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