Provider Demographics
NPI:1477072973
Name:MARSHALL DENTAL CARE
Entity Type:Organization
Organization Name:MARSHALL DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASIONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-364-8040
Mailing Address - Street 1:4199 WINCHESTER ROAD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20115
Mailing Address - Country:US
Mailing Address - Phone:540-364-8040
Mailing Address - Fax:540-364-8163
Practice Address - Street 1:4199 WINCHESTER ROAD
Practice Address - Street 2:SUITE H
Practice Address - City:MARSHALL
Practice Address - State:VA
Practice Address - Zip Code:20115
Practice Address - Country:US
Practice Address - Phone:540-364-8040
Practice Address - Fax:540-364-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty