Active NPI
Gregory Marra Jr., DMD
- Dentist
- Fort Bragg, NC
National Provider Identifier
1952710386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS040015
- Practice address
- 2817 Reilly St
Fort Bragg, NC 28310-7324 - Phone
- (910) 643-2196
- Fax
- (910) 396-7017
- NPI assigned
- Aug 11, 2014
- Last updated
- Aug 11, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS040015 | PA | Primary |
Addresses
Primary practice location
2817 Reilly St
Fort Bragg, NC 28310-7324
Mailing address
2817 Reilly St
Fort Bragg, NC 28310-7324
Phone (910) 643-2196
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 28, 2021 through Jul 28, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS040015 | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407715200000",
"number": "1952710386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2817 REILLY ST",
"city": "FORT BRAGG",
"state": "NC",
"postal_code": "283107324",
"telephone_number": "910-643-2196",
"fax_number": "910-396-7017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2817 REILLY ST",
"city": "FORT BRAGG",
"state": "NC",
"postal_code": "283107324",
"telephone_number": "910-643-2196",
"fax_number": "910-396-7017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARRA",
"first_name": "GREGORY",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-11",
"last_updated": "2014-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS040015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Bragg, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.