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General NPI Number Information
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NPI Number | 1588753859
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Entity Type | Organization
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Legal Business Name | H RICHARD MARSHALL JR DDS INC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 MAPLEWOOD AVE
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City | RONCEVERTE
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State | WV
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Zip | 24970
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Country | US
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Telephone | 304-645-3110
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Fax | 301-645-3209
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Provider Business Mailing Address
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Address Line | 120 MAPLEWOOD AVE
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City | RONCEVERTE
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State | WV
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Zip | 24970
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Country | US
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Telephone | 304-645-3110
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Fax | 301-645-3209
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. BONNIE M GRAGG
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Credential |
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Telephone | 304-645-3110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | WV1914
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License Number State | WV
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