Provider Demographics
NPI:1710198296
Name:MARSHALL, ANDREW D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2067 YGNACIO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3301
Mailing Address - Country:US
Mailing Address - Phone:925-934-1211
Mailing Address - Fax:925-934-9309
Practice Address - Street 1:2067 YGNACIO VALLEY RD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3301
Practice Address - Country:US
Practice Address - Phone:925-934-1211
Practice Address - Fax:925-934-9309
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist