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110 W Church St Creedmoor NC 27522-9747 | |
| (919) 528-4004 | |
| (919) 528-2211 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 110 W Church St, Creedmoor, North Carolina |
| Authorized Official Name and Position | Benjamin Victor Koren (OWNER) |
| Authorized Official Contact | 9195284004 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
110 W Church St Creedmoor NC 27522-9747 Ph: (919) 528-4004 | 110 W Church St Creedmoor NC 27522-9747 Ph: (919) 528-4004 |
| NPI Number | 1336170042 |
|---|---|
| Provider Enumeration Date | 07/05/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336170042 | NPI | - | NPPES |
| 5902042 | Medicaid | NC | |
| 017JW | Other | NC | BCBS GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 6997 (North Carolina) | Primary |
Kenneth R Marsh Dds Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1582 Hwy 56, Creedmoor, NC 27522 Phone: 919-528-1980 Fax: 919-528-8610 | |