Provider Demographics
NPI:1013093491
Name:MARSHALL, LILIANA MERCEDES (DMD)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:MERCEDES
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 1:2186 HARRIS AVE NE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4044
Mailing Address - Country:US
Mailing Address - Phone:321-723-2620
Mailing Address - Fax:
Practice Address - Street 1:2186 HARRIS AVE NE
Practice Address - Street 2:SUITE 3
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4044
Practice Address - Country:US
Practice Address - Phone:321-723-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL87441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist