Healthcare Provider Details

I. General information

NPI: 1184751752
Provider Name (Legal Business Name): MICHAEL MARSHALL D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7677 CENTER AVE SUITE 205
HUNTINGTON BEACH CA
92647-3074
US

IV. Provider business mailing address

7677 CENTER AVE SUITE 205
HUNTINGTON BEACH CA
92647-3074
US

V. Phone/Fax

Practice location:
  • Phone: 714-766-6560
  • Fax: 714-766-6563
Mailing address:
  • Phone: 714-766-6560
  • Fax: 714-766-6563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number32586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: