Provider Demographics
NPI:1073821948
Name:MARCIA L REMENTER DMD, P.A. IV
Entity Type:Organization
Organization Name:MARCIA L REMENTER DMD, P.A. IV
Other - Org Name:GREENSBORO DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-260-7156
Mailing Address - Street 1:2601 OAKCREST AVE STE D
Mailing Address - Street 2:2601F OAKCREST AVE.
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4719
Mailing Address - Country:US
Mailing Address - Phone:336-288-7704
Mailing Address - Fax:
Practice Address - Street 1:2601 OAKCREST AVE STE D
Practice Address - Street 2:2601F OAKCREST AVE.
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4719
Practice Address - Country:US
Practice Address - Phone:336-288-7704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty