MEDICARE: TED L MARSHALL DMD INC

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	3855	OK

General Provider Information

NPI Number	:	1437323466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TED L MARSHALL DMD INC

Provider Business Mailing Address
First Line	:	8830 S YALE AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-3551
Country	:	US
Telephone Number	:	918-492-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	8830 S YALE AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-3551
Country	:	US
Telephone Number	:	918-492-6200
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. TED LEE MARSHALL
Credential	:	DMD
Telephone Number	:	918-492-6200

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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