| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 110 W Church St, Creedmoor, North Carolina |
| Authorized Official Name and Position | Janet Lynn Corbley (CEO) |
| Authorized Official Contact | 9195280800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4112 Pleasant Valley Rd Ste 212 Raleigh NC 27612-2634 Ph: (919) 528-0800 | 110 W Church St Creedmoor NC 27522 Ph: (919) 528-0800 |
| NPI Number | 1144585886 |
|---|---|
| Provider Enumeration Date | 07/09/2012 |
| Last Update Date | 05/06/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144585886 | NPI | - | NPPES |
| 89016HP | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 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 | |