Provider Demographics
NPI:1942451240
Name:MARSHALL, TIMOTHY DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DEAN
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1512
Mailing Address - Country:US
Mailing Address - Phone:434-395-1228
Mailing Address - Fax:434-395-1232
Practice Address - Street 1:420 E 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1512
Practice Address - Country:US
Practice Address - Phone:434-395-1228
Practice Address - Fax:434-395-1232
Is Sole Proprietor?:No
Enumeration Date:2008-10-05
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014122201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice