Provider Demographics
NPI:1801816590
Name:MARSHALL, ROBERT N (DMD, MAGD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DMD, MAGD
Other - Prefix:
Other - First Name:AESTHETIC
Other - Middle Name:DENTAL
Other - Last Name:CENTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:177 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2543
Mailing Address - Country:US
Mailing Address - Phone:603-224-1743
Mailing Address - Fax:603-224-0774
Practice Address - Street 1:177 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2543
Practice Address - Country:US
Practice Address - Phone:603-224-1743
Practice Address - Fax:603-224-0774
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist