Provider Demographics
NPI:1649321845
Name:MARSHALL, BRYAN TIMOTHY (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:TIMOTHY
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 1:6152 NEW OSPREY PT
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34607-4017
Mailing Address - Country:US
Mailing Address - Phone:352-596-8988
Mailing Address - Fax:352-597-4427
Practice Address - Street 1:12009 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-7372
Practice Address - Country:US
Practice Address - Phone:352-596-8988
Practice Address - Fax:352-597-4427
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist