=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841216637
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARSHALL DENTAL ASSOCIATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1809 S WASHINGTON AVE
-----------------------------------------------------
City | MARSHALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75670-6855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-935-6282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1809 S WASHINGTON AVE
-----------------------------------------------------
City | MARSHALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75670-6855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. CHAD RICHARD REED
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 903-935-6282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------