MEDICARE: JAMES RANDALL MARSHALL DMD PLLC

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

General Provider Information

NPI Number	:	1699476010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES RANDALL MARSHALL DMD PLLC

Provider Business Mailing Address
First Line	:	4715 DIXIE RIVER RD STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-6737
Country	:	US
Telephone Number	:	980-224-7192
Fax Number	:

Provider Business Practice Location Address
First Line	:	4715 DIXIE RIVER RD STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-6737
Country	:	US
Telephone Number	:	980-224-7192
Fax Number	:

Authorized Official
Title or Position	:	OWNER / DENTIST
Name	:	DR. JAMES MARSHALL
Credential	:	DMD
Telephone Number	:	980-224-7192

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	03/13/2023

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