Provider Demographics
NPI:1043578966
Name:MARSHALL, MARTESIA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTESIA
Middle Name:A
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71949 HIGHWAY 111
Mailing Address - Street 2:#100B
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4826
Mailing Address - Country:US
Mailing Address - Phone:760-565-6055
Mailing Address - Fax:760-406-5068
Practice Address - Street 1:71949 HIGHWAY 111
Practice Address - Street 2:#100B
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4826
Practice Address - Country:US
Practice Address - Phone:760-565-6055
Practice Address - Fax:760-406-5068
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-28
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN12012025A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice