Provider Demographics
NPI:1609186444
Name:MARKS, BETH MORGAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:MORGAN
Last Name:MARKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 COVINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7311
Mailing Address - Country:US
Mailing Address - Phone:260-432-4329
Mailing Address - Fax:260-434-1570
Practice Address - Street 1:6221 COVINGTON RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-7311
Practice Address - Country:US
Practice Address - Phone:260-432-4329
Practice Address - Fax:260-434-1570
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009534122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist