Provider Demographics
NPI:1568687358
Name:ROBERT NELSON MARSHALL
Entity Type:Organization
Organization Name:ROBERT NELSON MARSHALL
Other - Org Name:AESTHETIC DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MAGD
Authorized Official - Phone:603-224-1743
Mailing Address - Street 1:177 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2543
Mailing Address - Country:US
Mailing Address - Phone:603-224-1743
Mailing Address - Fax:603-224-0774
Practice Address - Street 1:177 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2543
Practice Address - Country:US
Practice Address - Phone:603-224-1743
Practice Address - Fax:603-224-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30316466Medicaid