Healthcare Provider Details

I. General information

NPI: 1710178983
Provider Name (Legal Business Name): CHRISTOPHER W MARSHALL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 GLOUCESTER ROAD
SALUDA VA
23149-1297
US

IV. Provider business mailing address

655 GLOUCESTER ROAD P.O. BOX 1297
SALUDA VA
23149-1297
US

V. Phone/Fax

Practice location:
  • Phone: 804-758-2143
  • Fax: 804-758-4195
Mailing address:
  • Phone: 804-758-2143
  • Fax: 804-758-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401007689
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: