Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6894 | TX |
NPI | 1003004490 |
---|---|
Provider Name | Richard Irwin Marks |
First Address | Fort Worth, TX 76134 |
Second Address | Fort Worth, TX 76134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2007 |
Last Update Date | 10/10/2007 |