Provider Demographics
NPI:1497422679
Name:MARSHALL, BARRETT (DDS)
Entity Type:Individual
Prefix:
First Name:BARRETT
Middle Name:
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 1:132 RUDDIMAN DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-2730
Mailing Address - Country:US
Mailing Address - Phone:206-549-0323
Mailing Address - Fax:
Practice Address - Street 1:132 RUDDIMAN DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-2730
Practice Address - Country:US
Practice Address - Phone:206-549-0323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016011151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice