Provider Demographics
NPI:1346634250
Name:ANTHONY EDWARD MARRA, DDS, PLLC
Entity Type:Organization
Organization Name:ANTHONY EDWARD MARRA, DDS, PLLC
Other - Org Name:HUNTERSVILLE FAMILY AND COSMETIC DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/GENERAL DENTIST/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-892-7866
Mailing Address - Street 1:9620 HOLLY POINT DR STE 202
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4951
Mailing Address - Country:US
Mailing Address - Phone:704-892-7866
Mailing Address - Fax:704-892-0509
Practice Address - Street 1:9620 HOLLY POINT DR STE 202
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4951
Practice Address - Country:US
Practice Address - Phone:704-892-7866
Practice Address - Fax:704-892-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-28
Last Update Date:2015-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1760743926Medicaid