Provider Demographics
NPI:1427026723
Name:MARSHALL, CAROL ELAINE (DDS,MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ELAINE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 ERIN PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5400
Mailing Address - Country:US
Mailing Address - Phone:719-531-7111
Mailing Address - Fax:719-531-7129
Practice Address - Street 1:6025 ERIN PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5400
Practice Address - Country:US
Practice Address - Phone:719-531-7111
Practice Address - Fax:719-531-7129
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO62131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02062131Medicaid