Provider Demographics
NPI:1891836961
Name:MARSHALL, JENNIFER L (RDH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 26610
Mailing Address - Street 2:WUERZBURG DENTAL ACTIVITY CREDENTIALS OFFICE
Mailing Address - City:APO AE
Mailing Address - State:NY
Mailing Address - Zip Code:09244
Mailing Address - Country:US
Mailing Address - Phone:931-804-3933
Mailing Address - Fax:931-804-2524
Practice Address - Street 1:UNIT 26610
Practice Address - Street 2:WUERZBURG DENTAL ACTIVITY CREDENTIALS OFFICE
Practice Address - City:APO AE
Practice Address - State:NY
Practice Address - Zip Code:09244
Practice Address - Country:US
Practice Address - Phone:931-804-3933
Practice Address - Fax:931-804-2524
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2869124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist