Healthcare Provider Details

I. General information

NPI: 1285641399
Provider Name (Legal Business Name): MARK MARSHALL D.D.S. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5370 OBERLIN AVE
LORAIN OH
44053-3451
US

IV. Provider business mailing address

5370 OBERLIN AVE
LORAIN OH
44053-3451
US

V. Phone/Fax

Practice location:
  • Phone: 440-282-5121
  • Fax:
Mailing address:
  • Phone: 440-282-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK MARSHALL
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 440-282-5121