Individual provider Active NPI

Sung-Eun Lee Marshall, D.D.S.

  • General Practice Dentistry
  • Avondale, AZ
National Provider Identifier
1215272430
Registry record updated May 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D011286 Issued in AZ
Practice address
10210 W McDowell Rd Ste 140
Avondale, AZ 85392-4844
Phone
(480) 564-4981
NPI assigned
Nov 28, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 28539 TX
General Practice Dentistry 1223G0001X D011286 AZ Primary

Addresses

Primary practice location

10210 W McDowell Rd Ste 140
Avondale, AZ 85392-4844

Mailing address

204 N Bronco Cir
Payson, AZ 85541-4297
Phone (323) 616-5996

Other practice location 1

1100 Lowes Blvd
Killeen, TX 76542-5491
Phone (254) 449-8163

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL na Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D011286AZMDGeneral Practice Dentistry
28539TXMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652918400000",
    "number": "1215272430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 N BRONCO CIR",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855414297",
            "telephone_number": "323-616-5996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10210 W MCDOWELL RD STE 140",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853924844",
            "telephone_number": "480-564-4981"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Lowes Blvd",
            "address_purpose": "LOCATION",
            "city": "Killeen",
            "state": "TX",
            "postal_code": "765425491",
            "country_code": "US",
            "telephone_number": "254-449-8163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "SUNG-EUN",
        "middle_name": "LEE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-28",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "28539",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D011286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "na",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "10210 W McDowell Rd Ste 140",
            "city": "Avondale",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "853924844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Avondale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.