Provider Demographics
NPI:1407846975
Name:MARSHALL, ANDREW HEROD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:HEROD
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 1:110 MCMURRY BLVD
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37074-1108
Mailing Address - Country:US
Mailing Address - Phone:615-374-9181
Mailing Address - Fax:615-374-9187
Practice Address - Street 1:110 MCMURRY BLVD
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37074-1108
Practice Address - Country:US
Practice Address - Phone:615-374-9181
Practice Address - Fax:615-374-9187
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440279Medicaid