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General NPI Number Information
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NPI Number | 1770121428
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Entity Type | Organization
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Legal Business Name | LAUREL MARSHALL, DMD, MS, LLC
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 147 E BRIDGE ST
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City | ELYRIA
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State | OH
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Zip | 44035-5218
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Country | US
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Telephone | 419-202-4727
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Fax |
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Provider Business Mailing Address
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Address Line | 984 S NORWALK RD W
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City | NORWALK
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State | OH
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Zip | 44857-9017
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Country | US
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Telephone | 419-202-4727
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | LAUREL K MARSHALL
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Credential | DMD, MS
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Telephone | 419-202-4727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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