Healthcare Provider Details

I. General information

NPI: 1073532644
Provider Name (Legal Business Name): MELANIE KRISTEN MARSHALL DDS, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S SALISBURY AVE
SPENCER NC
28159-2065
US

IV. Provider business mailing address

PO BOX 29
SPENCER NC
28159-0029
US

V. Phone/Fax

Practice location:
  • Phone: 704-636-7215
  • Fax:
Mailing address:
  • Phone: 704-636-7215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8640
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number200401268
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: