Provider Demographics
NPI:1245253186
Name:MARSHALL, MARY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LYNN
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 1:1003 W MCGALLIARD RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1768
Mailing Address - Country:US
Mailing Address - Phone:765-288-1307
Mailing Address - Fax:765-741-1649
Practice Address - Street 1:1003 W MCGALLIARD RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1768
Practice Address - Country:US
Practice Address - Phone:765-288-1307
Practice Address - Fax:765-741-1649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist