Provider Demographics
NPI:1033728530
Name:WORDEN, MARCUS WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:WILLIAM
Last Name:WORDEN
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 1:12922 COUNTY RD. 185
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757
Mailing Address - Country:US
Mailing Address - Phone:770-243-0070
Mailing Address - Fax:
Practice Address - Street 1:2336 ABERDEEN DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1943
Practice Address - Country:US
Practice Address - Phone:903-581-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice