Provider Demographics
NPI:1245390830
Name:MARSHALL, E GORDON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:E
Middle Name:GORDON
Last Name:MARSHALL
Suffix:JR
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 1:18 SOUTH MAIN
Mailing Address - Street 2:SUITE 516
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501
Mailing Address - Country:US
Mailing Address - Phone:254-778-3932
Mailing Address - Fax:254-778-0098
Practice Address - Street 1:18 SOUTH MAIN
Practice Address - Street 2:SUITE 516
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501
Practice Address - Country:US
Practice Address - Phone:254-778-3932
Practice Address - Fax:254-778-0098
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice