Provider Demographics
NPI:1780701334
Name:LYALL, MARSHALL ARNOLD (DDS)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:ARNOLD
Last Name:LYALL
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 1:5291 GREENWICH RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6037
Mailing Address - Country:US
Mailing Address - Phone:757-493-8100
Mailing Address - Fax:
Practice Address - Street 1:5291 GREENWICH RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6037
Practice Address - Country:US
Practice Address - Phone:757-493-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist