MEDICARE: PHILIP LEWIS MARSHALL D.M.D.

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	1223G0001X	General Practice Dentistry	DN0011485	FL

General Provider Information

NPI Number	:	1124129531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP LEWIS MARSHALL D.M.D.

Provider Business Mailing Address
First Line	:	4080 LEA MARIE ISLAND DR
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-9191
Country	:	US
Telephone Number	:	941-627-8872
Fax Number	:	941-629-2498

Provider Business Practice Location Address
First Line	:	3443 TAMIAMI TRL
Second Line	:	SUITE F
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8159
Country	:	US
Telephone Number	:	941-629-8187
Fax Number	:	941-629-2498

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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Practice Location Address:

3443 TAMIAMI TRL , SUITE F
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1245331677 — JUDY KAY YATES MARSHALL D.M.D.
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Practice Location Address:

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Practice Location Address:

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Practice Location Address:

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