Healthcare Provider Details

I. General information

NPI: 1346518834
Provider Name (Legal Business Name): MARSHALL ORTHODONTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 6TH AVE S
GREAT FALLS MT
59405-3013
US

IV. Provider business mailing address

2525 6TH AVE S
GREAT FALLS MT
59405-3013
US

V. Phone/Fax

Practice location:
  • Phone: 406-761-0314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2384
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MARSHALL
Title or Position: PRESIDENT
Credential:
Phone: 406-761-0314