Provider Demographics
NPI:1952543860
Name:ROBERT C. MARSHALL, D.D.S., P.C.
Entity Type:Organization
Organization Name:ROBERT C. MARSHALL, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-534-1010
Mailing Address - Street 1:2295 PARKLAKE DR NE
Mailing Address - Street 2:STE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2844
Mailing Address - Country:US
Mailing Address - Phone:678-534-1010
Mailing Address - Fax:678-534-1012
Practice Address - Street 1:2295 PARKLAKE DR NE
Practice Address - Street 2:STE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2844
Practice Address - Country:US
Practice Address - Phone:678-534-1010
Practice Address - Fax:678-534-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN010458261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental