Provider Demographics
NPI:1619075603
Name:MARSHALL, RONALD RAY (DDS LTD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:RAY
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DDS LTD
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:R
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS LTD
Mailing Address - Street 1:6891 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117
Mailing Address - Country:US
Mailing Address - Phone:702-255-6768
Mailing Address - Fax:702-255-3416
Practice Address - Street 1:6891 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-255-6768
Practice Address - Fax:702-255-3416
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2392122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist