Provider Demographics
NPI:1750504148
Name:MARSHALL, WILLIAM WALTER II (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALTER
Last Name:MARSHALL
Suffix:II
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 1:301 KARAT PLACE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-4144
Mailing Address - Country:US
Mailing Address - Phone:660-385-3413
Mailing Address - Fax:660-385-7069
Practice Address - Street 1:1609 MAFFRY AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1960
Practice Address - Country:US
Practice Address - Phone:660-385-3413
Practice Address - Fax:660-385-7069
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020231921223G0001X
OK52841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice