Provider Demographics
NPI:1275667370
Name:MARSHALL, CRAIG B (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:B
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 1:5244 NW BLUFF CIR
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-3470
Mailing Address - Country:US
Mailing Address - Phone:816-587-3081
Mailing Address - Fax:
Practice Address - Street 1:6502 NW PRAIRIE VIEW RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2303
Practice Address - Country:US
Practice Address - Phone:816-741-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0142011223G0001X
KS61321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice