MEDICARE: DR. TED L 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	3855	OK

General Provider Information

NPI Number	:	1669412391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TED L MARSHALL D.M.D.

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	:	918-481-5265

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	:	918-481-5265

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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