Provider Demographics
NPI:1316962913
Name:THEWS, MARVIN E JR (DDS)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:E
Last Name:THEWS
Suffix:JR
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 1:1940 BRAEBURN DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7383
Mailing Address - Country:US
Mailing Address - Phone:540-989-6648
Mailing Address - Fax:540-989-5340
Practice Address - Street 1:1940 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7383
Practice Address - Country:US
Practice Address - Phone:540-989-6648
Practice Address - Fax:540-989-5340
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010043091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics