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NPI Code Detail

MEDICARE: DR. DAVID RANDOLPH MARSHALL JR. DDS

MEDICARE: DR. DAVID RANDOLPH MARSHALL JR. DDS
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
11223G0001XGeneral Practice Dentistry0442000392VA

General Provider Information

NPI Number : 1568070829
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID RANDOLPH MARSHALL JR. DDS
Provider Business Mailing Address
First Line : 13932 INDIANA ST APT 101
Second Line :
City : BRISTOL
State : VA
Zip : 24201-2230
Country : US
Telephone Number : 434-284-3606
Fax Number :
Provider Business Practice Location Address
First Line : 616 CAMPUS DR STE 100
Second Line :
City : ABINGDON
State : VA
Zip : 24210-9706
Country : US
Telephone Number : 276-525-4487
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2020
Last Update Date : 07/22/2020

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