MEDICARE: DR. BRUCE IAN MARSHALL D.D.S., M.P.H.,

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	041980	NY

General Provider Information

NPI Number	:	1699771733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE IAN MARSHALL D.D.S., M.P.H.,

Provider Business Mailing Address
First Line	:	PO BOX 444
Second Line	:
City	:	SUGAR LOAF
State	:	NY
Zip	:	10981-0444
Country	:	US
Telephone Number	:	845-469-9937
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 MOUNTAINVIEW DR
Second Line	:
City	:	CHESTER
State	:	NY
Zip	:	10918-3106
Country	:	US
Telephone Number	:	845-786-4204
Fax Number	:	845-786-4022

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/08/2007

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