MEDICARE: DR. ANDREW CHRISTIAN MARSHALL DMD

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	4195	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4195	OTHER	SC	DENTIST

General Provider Information

NPI Number	:	1710917265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW CHRISTIAN MARSHALL DMD

Provider Business Mailing Address
First Line	:	3295 FORNEY STREET
Second Line	:
City	:	FORT JACKSON
State	:	SC
Zip	:	29207-5780
Country	:	US
Telephone Number	:	803-751-6213
Fax Number	:	803-751-6886

Provider Business Practice Location Address
First Line	:	3295 FORNEY STREET
Second Line	:
City	:	FORT JACKSON
State	:	SC
Zip	:	29207-5780
Country	:	US
Telephone Number	:	803-751-6213
Fax Number	:	803-751-6886

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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