MEDICARE: DR. CYNTHIA F. 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	D8461	OR

General Provider Information

NPI Number	:	1821081704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA F. MARSHALL DMD

Provider Business Mailing Address
First Line	:	30469 BUTTE CREEK RD
Second Line	:
City	:	LEBANON
State	:	OR
Zip	:	97355-9265
Country	:	US
Telephone Number	:	541-258-4746
Fax Number	:	541-258-4745

Provider Business Practice Location Address
First Line	:	175 PARK ST
Second Line	:
City	:	LEBANON
State	:	OR
Zip	:	97355-4225
Country	:	US
Telephone Number	:	541-258-4746
Fax Number	:	541-258-4745

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/08/2007

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