Provider Demographics
NPI:1336281633
Name:MARSH, YVONNE RICHARDSON (DDS)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:RICHARDSON
Last Name:MARSH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2271
Mailing Address - Country:US
Mailing Address - Phone:978-774-2279
Mailing Address - Fax:
Practice Address - Street 1:26 LOCUST ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2271
Practice Address - Country:US
Practice Address - Phone:978-774-2279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20746122300000X
MADN207461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110079401AMedicaid
MA0297569Medicare PIN