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Organization

MARTIN TYRRELL WASHINGTON DISTRICT HEALTH DEPT

Active
Other names
Martin Tyrrell Washington District Dental Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
RONDA B PHELPS (ADMINISTRATIVE ASSISTANT II)
(252) 793-3023
Entity
Organization

Contact information

Practice address
198 NC HIGHWAY 45 N, PLYMOUTH, NC 27962-9232
(252) 793-3023
(252) 791-3159
Mailing address
198 NC HIGHWAY 45 N, PLYMOUTH, NC 27962-9232
(252) 793-3023
(252) 791-3159

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
07059
BLUE CROSS
NC
05
3404410
NC
Enumeration date
11/30/2005
Last updated
07/21/2022
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