Provider Demographics
NPI:1356567259
Name:MARSHALL, THOMAS WAYNE (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WAYNE
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 VIRGINIA PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-3508
Mailing Address - Country:US
Mailing Address - Phone:972-540-2800
Mailing Address - Fax:972-542-1182
Practice Address - Street 1:2411 VIRGINIA PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-3508
Practice Address - Country:US
Practice Address - Phone:972-540-2800
Practice Address - Fax:972-542-1182
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice