Individual provider Active NPI

Duane Glenn Marshall, DMD

  • Dentist
  • Rio Rancho, NM
National Provider Identifier
1225342918
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DD3353 Issued in NM
Practice address
4405 Jager Dr NE Ste C1
Rio Rancho, NM 87144-5715
Phone
(505) 692-8167
NPI assigned
Aug 5, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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 DD3353 NM
Dentist 122300000X DD3353 NM Primary

Addresses

Primary practice location

4405 Jager Dr NE Ste C1
Rio Rancho, NM 87144-5715

Mailing address

2050A Second St SE
377 MDG
Kirtland Afb, NM 87117-5522
Phone (505) 846-3027

Other practice location 1

2050A Second St SE
377 MDG
Kirtland Afb, NM 87117-5522
Phone (505) 846-3027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170620001545 NM Order and Referring Only - DentistPractitioner - Dentist 1557639333

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain View Family Dentists LLC Current Accepting new patients

Locations

4405 Jager Dr NE
Ste C1
Rio Rancho, NM 87144
Phone (505) 405-9300

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1225342918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050A SECOND ST SE",
            "address_2": "377 MDG",
            "city": "KIRTLAND AFB",
            "state": "NM",
            "postal_code": "871175522",
            "telephone_number": "505-846-3027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 JAGER DR NE STE C1",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871445715",
            "telephone_number": "505-692-8167"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2050A SECOND ST SE",
            "address_2": "377 MDG",
            "address_purpose": "LOCATION",
            "city": "KIRTLAND AFB",
            "state": "NM",
            "postal_code": "871175522",
            "country_code": "US",
            "telephone_number": "505-846-3027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "DUANE",
        "middle_name": "GLENN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-05",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD3353",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD3353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rio Rancho, NM

Sources for this page

Verify at the official NPI Registry.