Provider Demographics
NPI:1144389016
Name:MARSHALL, TODD WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:WILLIAM
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1782 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6059
Mailing Address - Country:US
Mailing Address - Phone:651-645-6107
Mailing Address - Fax:
Practice Address - Street 1:6437 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-2174
Practice Address - Country:US
Practice Address - Phone:763-531-7177
Practice Address - Fax:763-535-6284
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND99351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice