MEDICARE: CHRISTIAN D MARSH 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	122300000X	Dentist	6245-15	WI

General Provider Information

NPI Number	:	1316107717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN D MARSH DDS

Provider Business Mailing Address
First Line	:	325 E MAIN ST
Second Line	:	PO BOX 490
City	:	WINNECONNE
State	:	WI
Zip	:	54986-9703
Country	:	US
Telephone Number	:	920-582-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 E MAIN ST
Second Line	:
City	:	WINNECONNE
State	:	WI
Zip	:	54986-9703
Country	:	US
Telephone Number	:	920-582-4343
Fax Number	:

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	01/01/2014

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