Provider Demographics
NPI:1962483768
Name:MARSHALL, HAROLD ODELL JR (DDS)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:ODELL
Last Name:MARSHALL
Suffix:JR
Gender:M
Credentials:DDS
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Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE B-101
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-7622
Mailing Address - Fax:972-566-7255
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE B-101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-7622
Practice Address - Fax:972-566-7255
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TX11398204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D11398Medicare UPIN
TXT14604Medicare ID - Type Unspecified