Provider Demographics
NPI:1285892174
Name:MARSH, KENNETH REID (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:REID
Last Name:MARSH
Suffix:
Gender:M
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:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-0596
Mailing Address - Country:US
Mailing Address - Phone:919-528-8610
Mailing Address - Fax:919-528-8610
Practice Address - Street 1:1582 HWY 56
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522
Practice Address - Country:US
Practice Address - Phone:919-528-1980
Practice Address - Fax:919-528-8610
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909754Medicaid