Provider Demographics
NPI:1548470560
Name:MARSHALL, SCOTT HOWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:HOWARD
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 KING ST SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3506
Mailing Address - Country:US
Mailing Address - Phone:770-435-7358
Mailing Address - Fax:770-435-1020
Practice Address - Street 1:2874 KING ST SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3506
Practice Address - Country:US
Practice Address - Phone:770-435-7358
Practice Address - Fax:770-435-1020
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA105621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice