Healthcare Provider Details

I. General information

NPI: 1801107776
Provider Name (Legal Business Name): MICHAEL W MARSHALL DDS. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7677 CENTER AVE SUITE 206
HUNTINGTON BEACH CA
92647-3074
US

IV. Provider business mailing address

7677 CENTER AVE SUITE 206
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 TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number59337
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number32586
License Number StateCA

VIII. Authorized Official

Name: MS. JACKIE N SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 714-766-6560