Provider Demographics
NPI:1184961690
Name:DAVID T. MARSHALL, DDS, PC
Entity type:Organization
Organization Name:DAVID T. MARSHALL, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:TROUT
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-489-4221
Mailing Address - Street 1:110 KINGSLEY LN
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4614
Mailing Address - Country:US
Mailing Address - Phone:757-489-4221
Mailing Address - Fax:757-423-5930
Practice Address - Street 1:110 KINGSLEY LN
Practice Address - Street 2:SUITE 203
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4614
Practice Address - Country:US
Practice Address - Phone:757-489-4221
Practice Address - Fax:757-423-5930
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty