Provider Demographics
NPI:1003190968
Name:MARSHALL, JAMES RANDALL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RANDALL
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BEE STREET
Mailing Address - Street 2:DC 500
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425
Mailing Address - Country:US
Mailing Address - Phone:843-792-1904
Mailing Address - Fax:843-792-2212
Practice Address - Street 1:29 BEE STREET
Practice Address - Street 2:DC 500
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425
Practice Address - Country:US
Practice Address - Phone:843-792-1904
Practice Address - Fax:843-792-2212
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist