Healthcare Provider Details

I. General information

NPI: 1952388514
Provider Name (Legal Business Name): THOMAS S MARSHALL DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2005
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N UNIVERSITY AVE
ANN ARBOR MI
48109-1078
US

IV. Provider business mailing address

1011 N UNIVERSITY AVE
ANN ARBOR MI
48109-1078
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-1558
  • Fax: 734-647-4024
Mailing address:
  • Phone: 734-764-1558
  • Fax: 734-647-4024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2901012338
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: