Provider Demographics
NPI:1932794401
Name:MARSHALL DENTAL GROUP, INC. A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:MARSHALL DENTAL GROUP, INC. A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:ESCALON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:209-281-4109
Mailing Address - Street 1:1220 LA MESA ST
Mailing Address - Street 2:
Mailing Address - City:ESCALON
Mailing Address - State:CA
Mailing Address - Zip Code:95320-1688
Mailing Address - Country:US
Mailing Address - Phone:209-838-7191
Mailing Address - Fax:
Practice Address - Street 1:1220 LA MESA ST
Practice Address - Street 2:
Practice Address - City:ESCALON
Practice Address - State:CA
Practice Address - Zip Code:95320-1688
Practice Address - Country:US
Practice Address - Phone:209-838-7191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental