Provider Demographics
NPI:1710022645
Name:MARSHALL, GLORY B (DDS, MS)
Entity Type:Individual
Prefix:
First Name:GLORY
Middle Name:B
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 E BASSE RD STE 155
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1806
Mailing Address - Country:US
Mailing Address - Phone:210-822-1110
Mailing Address - Fax:210-822-1379
Practice Address - Street 1:999 E BASSE RD STE 155
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1806
Practice Address - Country:US
Practice Address - Phone:210-822-1110
Practice Address - Fax:210-822-1379
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics