MEDICARE: LILIANA MARSHALL DMD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN17553	FL

General Provider Information

NPI Number	:	1083974901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILIANA MARSHALL DMD PLLC

Provider Business Mailing Address
First Line	:	2186 HARRIS AVE NE STE 3
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4044
Country	:	US
Telephone Number	:	321-723-2620
Fax Number	:	321-722-1610

Provider Business Practice Location Address
First Line	:	2186 HARRIS AVE NE STE 3
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4044
Country	:	US
Telephone Number	:	321-723-2620
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LILIANA M MARSHALL
Credential	:	D.M.D
Telephone Number	:	321-723-2620

Provider Enumeration Date	:	05/24/2012
Last Update Date	:	09/05/2013

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