Provider Demographics
NPI:1023352200
Name:MARSHALL, WILLIAM ALEXANDER (DMD, MS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALEXANDER
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N PINE ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1605
Mailing Address - Country:US
Mailing Address - Phone:864-585-8709
Mailing Address - Fax:
Practice Address - Street 1:319 N PINE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1605
Practice Address - Country:US
Practice Address - Phone:864-585-8709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC71241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics