Provider Demographics
NPI:1699771733
Name:MARSHALL, BRUCE IAN (DDS, MPH,)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:IAN
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DDS, MPH,
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 444
Mailing Address - Street 2:
Mailing Address - City:SUGAR LOAF
Mailing Address - State:NY
Mailing Address - Zip Code:10981-0444
Mailing Address - Country:US
Mailing Address - Phone:845-469-9937
Mailing Address - Fax:
Practice Address - Street 1:41 MOUNTAINVIEW DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-3106
Practice Address - Country:US
Practice Address - Phone:845-786-4204
Practice Address - Fax:845-786-4022
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0419801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice