Provider Demographics
NPI:1275645897
Name:MARSHALL, MARY PAT ADAMS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY PAT
Middle Name:ADAMS
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 DENINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5091
Mailing Address - Country:US
Mailing Address - Phone:864-923-5707
Mailing Address - Fax:
Practice Address - Street 1:9100 DENINGTON DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5091
Practice Address - Country:US
Practice Address - Phone:864-923-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4246122300000X
KY8999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist