Provider Demographics
NPI:1407915705
Name:MARSHALL, KEVIN D (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MOUNTAINVIEW BLVD
Mailing Address - Street 2:PO BOX 269
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6748
Mailing Address - Country:US
Mailing Address - Phone:973-694-3090
Mailing Address - Fax:
Practice Address - Street 1:141 MOUNTAINVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6748
Practice Address - Country:US
Practice Address - Phone:973-694-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice