Provider Demographics
NPI:1215272430
Name:MARSHALL, SUNG-EUN LEE (DDS)
Entity type:Individual
Prefix:
First Name:SUNG-EUN
Middle Name:LEE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N BRONCO CIR
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4297
Mailing Address - Country:US
Mailing Address - Phone:323-616-5996
Mailing Address - Fax:
Practice Address - Street 1:10210 W MCDOWELL RD STE 140
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4844
Practice Address - Country:US
Practice Address - Phone:480-564-4981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX285391223G0001X
AZD0112861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice