Provider Demographics
NPI:1790539138
Name:MARSHALL ORTHODONTICS LLC
Entity Type:Organization
Organization Name:MARSHALL ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:864-336-2965
Mailing Address - Street 1:551 HARRISON BRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680
Mailing Address - Country:US
Mailing Address - Phone:864-336-2965
Mailing Address - Fax:864-342-7208
Practice Address - Street 1:551 HARRISON BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680
Practice Address - Country:US
Practice Address - Phone:864-336-2965
Practice Address - Fax:864-342-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty