Provider Demographics
NPI:1154400380
Name:EVICK, MARCIEA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARCIEA
Middle Name:
Last Name:EVICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-5702
Mailing Address - Country:US
Mailing Address - Phone:304-636-5800
Mailing Address - Fax:304-636-0971
Practice Address - Street 1:600 S RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-5702
Practice Address - Country:US
Practice Address - Phone:304-636-5800
Practice Address - Fax:304-636-0971
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV35981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice