MEDICARE: DR. CRAIG B MARSHALL DDS

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	014201	MO
2	1223G0001X	General Practice Dentistry	6132	KS

General Provider Information

NPI Number	:	1275667370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG B MARSHALL DDS

Provider Business Mailing Address
First Line	:	5244 NW BLUFF CIR
Second Line	:
City	:	PARKVILLE
State	:	MO
Zip	:	64152-3470
Country	:	US
Telephone Number	:	816-587-3081
Fax Number	:

Provider Business Practice Location Address
First Line	:	6502 NW PRAIRIE VIEW RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-2303
Country	:	US
Telephone Number	:	816-741-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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