Provider Demographics
NPI:1679564363
Name:MARSHALL, ERIC SETH (DMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SETH
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 NORTH MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573
Mailing Address - Country:US
Mailing Address - Phone:914-939-3278
Mailing Address - Fax:914-939-3279
Practice Address - Street 1:21 NORTH MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-939-3278
Practice Address - Fax:914-939-3279
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0386821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00857869Medicaid
CT003091147Medicaid