Provider Demographics
NPI:1861380511
Name:MARSHALL, AMANDA KRISTEN (DMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KRISTEN
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 1:1923 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-5654
Mailing Address - Country:US
Mailing Address - Phone:423-317-9344
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:5500 CREEKWOOD PARK BLVD
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-1200
Practice Address - Country:US
Practice Address - Phone:865-986-8082
Practice Address - Fax:865-986-5890
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN129851223G0001X
AZD012536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist