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General NPI Number Information
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NPI Number | 1639677800
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Entity Type | Organization
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Legal Business Name | MARCUS BRIAN WARD, DMD, PA
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 3912 EAST 10TH ST.
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City | GREENVILLE
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State | NC
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Zip | 27858
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Country | US
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Telephone | 252-944-3918
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 467
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City | CHOCOWINITY
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State | NC
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Zip | 27817-0467
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARCUS BRIAN WARD
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Credential | DMD
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Telephone | 252-944-3918
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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 | 3394
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License Number State | NC
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