Provider Demographics
NPI:1194104158
Name:MARSHALL, ZACHARY PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:PAUL
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 W CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2506
Mailing Address - Country:US
Mailing Address - Phone:715-829-9576
Mailing Address - Fax:
Practice Address - Street 1:4110 W CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2506
Practice Address - Country:US
Practice Address - Phone:715-829-9576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-23
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001114122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist