Provider Demographics
NPI:1659395143
Name:MARSHALL, STEVEN T (DDS)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:T
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 N OAKLAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3018
Mailing Address - Country:US
Mailing Address - Phone:417-326-6061
Mailing Address - Fax:417-326-3537
Practice Address - Street 1:1300 N OAKLAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-3018
Practice Address - Country:US
Practice Address - Phone:417-326-6061
Practice Address - Fax:417-326-3537
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0134961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
792045OtherUNITED CONCORDIA
102763OtherBLUE CROSS