MEDICARE: LILIANA MERCEDES MARSHALL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	87441	FL

General Provider Information

NPI Number	:	1013093491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIANA MERCEDES MARSHALL DMD

Provider Business Mailing Address
First Line	:	2186 HARRIS AVE NE
Second Line	:	SUITE 3
City	:	PALM BAY
State	:	FL
Zip	:	32905-4044
Country	:	US
Telephone Number	:	321-723-2620
Fax Number	:

Provider Business Practice Location Address
First Line	:	2186 HARRIS AVE NE
Second Line	:	SUITE 3
City	:	PALM BAY
State	:	FL
Zip	:	32905-4044
Country	:	US
Telephone Number	:	321-723-2620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2006
Last Update Date	:	09/05/2013

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