Provider Demographics
NPI:1821005679
Name:MARSHALL, LYNNE LESLIE (DMD)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:LESLIE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TROWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BOURNE
Mailing Address - State:MA
Mailing Address - Zip Code:02532-3660
Mailing Address - Country:US
Mailing Address - Phone:508-759-7200
Mailing Address - Fax:508-759-7219
Practice Address - Street 1:1 TROWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532
Practice Address - Country:US
Practice Address - Phone:508-759-7200
Practice Address - Fax:508-759-7219
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11722OtherBLUE CROSS BLUE SHIELD