Provider Demographics
NPI:1992881544
Name:MARSH, PATRICK FABIAN (DDS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:FABIAN
Last Name:MARSH
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 1:1321 OBERLIN RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2052
Mailing Address - Country:US
Mailing Address - Phone:919-821-0008
Mailing Address - Fax:919-821-0010
Practice Address - Street 1:1321 OBERLIN RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2052
Practice Address - Country:US
Practice Address - Phone:919-821-0008
Practice Address - Fax:919-821-0010
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC45111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995484Medicaid
NC8995484Medicaid