Provider Demographics
NPI:1154331395
Name:MARSHALL, JOHN A (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
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 1:180 ELSBREE STREET
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720
Mailing Address - Country:US
Mailing Address - Phone:508-672-1069
Mailing Address - Fax:508-672-3848
Practice Address - Street 1:180 ELSBREE STREET
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-672-1069
Practice Address - Fax:508-672-3848
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187301223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX20035Medicare ID - Type UnspecifiedMEDICARE ID#