Provider Demographics
NPI:1053412544
Name:MARSHALL, DENNIS R (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
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 1:119 N EL CAMINO REAL
Mailing Address - Street 2:#A
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5397
Mailing Address - Country:US
Mailing Address - Phone:760-753-5544
Mailing Address - Fax:760-753-5877
Practice Address - Street 1:119 N EL CAMINO REAL
Practice Address - Street 2:#A
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5397
Practice Address - Country:US
Practice Address - Phone:760-753-5544
Practice Address - Fax:760-753-5877
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice