Provider Demographics
NPI:1073532644
Name:MARSHALL, MELANIE KRISTEN (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:KRISTEN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:NC
Mailing Address - Zip Code:28159-0029
Mailing Address - Country:US
Mailing Address - Phone:704-636-7215
Mailing Address - Fax:
Practice Address - Street 1:902 S SALISBURY AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NC
Practice Address - Zip Code:28159-2065
Practice Address - Country:US
Practice Address - Phone:704-636-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86401223S0112X
NC200401268174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902037Medicaid
NC5903242Medicaid