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General NPI Number Information
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NPI Number | 1144920349
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Entity Type | Individual
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Provider Name | SANDRA ANN MARSHALL DDS
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 4201 CENTRAL AVE NW STE F1
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-1669
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Country | US
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Telephone | 505-843-7172
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Fax | 505-352-6689
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Provider Business Mailing Address
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Address Line | 7508 MCNERNEY AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-2224
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Country | US
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Telephone | 505-908-1981
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DB-2023-0093
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License Number State | NM
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