Provider Demographics
NPI:1952684169
Name:MARSHALL, MOLLY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:MARIE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 COLUMBIA HOUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7777
Mailing Address - Country:US
Mailing Address - Phone:360-619-5198
Mailing Address - Fax:
Practice Address - Street 1:2404 COLUMBIA HOUSE BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7777
Practice Address - Country:US
Practice Address - Phone:360-619-5198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD95961223G0001X
WADE602431251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice