Provider Demographics
NPI:1518066117
Name:DAGGS-MARSHALL, ELISE J (DDS)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:J
Last Name:DAGGS-MARSHALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:J
Other - Last Name:DAGGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6226 N 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-6241
Mailing Address - Country:US
Mailing Address - Phone:602-612-2435
Mailing Address - Fax:
Practice Address - Street 1:6226 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-6241
Practice Address - Country:US
Practice Address - Phone:602-612-2435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA337451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice