Provider Demographics
NPI:1316964851
Name:MARSHALL, JOHN PRESTON (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PRESTON
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:PO BOX 408
Mailing Address - Street 2:215 CENTER ST
Mailing Address - City:SHERIDAN
Mailing Address - State:MI
Mailing Address - Zip Code:48884
Mailing Address - Country:US
Mailing Address - Phone:989-291-3302
Mailing Address - Fax:989-291-3078
Practice Address - Street 1:215 CENTER ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MI
Practice Address - Zip Code:48884
Practice Address - Country:US
Practice Address - Phone:989-291-3302
Practice Address - Fax:989-291-3302
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice