Provider Demographics
NPI:1629387089
Name:MARKS, KATHRYN RICKS (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:RICKS
Last Name:MARKS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 WOOD HOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6625
Mailing Address - Country:US
Mailing Address - Phone:517-582-2335
Mailing Address - Fax:
Practice Address - Street 1:23 RD MEDICAL GROUP
Practice Address - Street 2:3278 MITCHELL BLVD
Practice Address - City:MOODY A F B
Practice Address - State:GA
Practice Address - Zip Code:31699-1500
Practice Address - Country:US
Practice Address - Phone:229-257-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist