Provider Demographics
NPI:1821081704
Name:MARSHALL, CYNTHIA F (DMD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:F
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30469 BUTTE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-9265
Mailing Address - Country:US
Mailing Address - Phone:541-258-4746
Mailing Address - Fax:541-258-4745
Practice Address - Street 1:175 PARK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-4225
Practice Address - Country:US
Practice Address - Phone:541-258-4746
Practice Address - Fax:541-258-4745
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD84611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice