Provider Demographics
NPI:1588135420
Name:MARSHALL, CANDACE KIERA (DDS)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:KIERA
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:PO BOX 2909
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-2909
Mailing Address - Country:US
Mailing Address - Phone:318-614-0047
Mailing Address - Fax:
Practice Address - Street 1:5040 E INTERSTATE 30 STE 100
Practice Address - Street 2:
Practice Address - City:FATE
Practice Address - State:TX
Practice Address - Zip Code:75189-8545
Practice Address - Country:US
Practice Address - Phone:469-745-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70421223G0001X
TX380371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice