Active NPI
Jerry Lee Marshall, D.M.D.
- General Practice Dentistry
- North Pekin, IL
National Provider Identifier
1528118239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- Practice address
- 135A-B Radio City Drive
North Pekin, IL 61554 - Phone
- (309) 382-2229
- Fax
- (309) 382-1155
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IL | Primary |
Addresses
Primary practice location
135A-B Radio City Drive
North Pekin, IL 61554
Mailing address
466 S Prairie St
Bethalto, IL 62010-1816
Phone (618) 377-2482
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
| License | State | Type | Specialty |
|---|---|---|---|
| 019-016323 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528118239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "466 S PRAIRIE ST",
"city": "BETHALTO",
"state": "IL",
"postal_code": "620101816",
"telephone_number": "618-377-2482",
"fax_number": "618-377-5228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "135A-B RADIO CITY DRIVE",
"city": "NORTH PEKIN",
"state": "IL",
"postal_code": "61554",
"telephone_number": "309-382-2229",
"fax_number": "309-382-1155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALL",
"first_name": "JERRY",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Pekin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.