Healthcare Provider Details

I. General information

NPI: 1609801497
Provider Name (Legal Business Name): JAMES B MARSHALL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 MAIN STREET SOUTH
WOODBURY CT
06798
US

IV. Provider business mailing address

357 MAIN STREET SOUTH PO BOX 593
WOODBURY CT
06798
US

V. Phone/Fax

Practice location:
  • Phone: 203-263-2681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number07617
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: