MEDICARE: MARC W WORDEN DDS FAMILY DENTISTRY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1902416704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARC W WORDEN DDS FAMILY DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	12922 COUNTY RD 185
Second Line	:
City	:	BULLARD
State	:	TX
Zip	:	75757
Country	:	US
Telephone Number	:	770-243-0070
Fax Number	:

Provider Business Practice Location Address
First Line	:	2336 ABERDEEN DR
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-1943
Country	:	US
Telephone Number	:	903-581-1646
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARCUS W WORDEN
Credential	:	DDS
Telephone Number	:	770-243-0070

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	08/06/2020

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