Provider Demographics
NPI:1760743926
Name:MARRA, ANTHONY EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:EDWARD
Last Name:MARRA
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 1:1342 TORRENCE CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-9401
Mailing Address - Country:US
Mailing Address - Phone:304-290-9580
Mailing Address - Fax:
Practice Address - Street 1:1212 SPRUCE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3385
Practice Address - Country:US
Practice Address - Phone:704-825-3455
Practice Address - Fax:704-825-3480
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice