William Walter Marshall II, D.D.S.
Individual provider Active NPI General Practice Dentistry · Macon, MO
NPI 1750504148 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1750504148
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2002023192 (MO)
- Practice address
- 1609 Maffry Ave
Macon, MO 63552-1960 - Phone
- (660) 385-3413
- Fax
- (660) 385-7069
- NPI assigned
- Apr 11, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161006000837 | MO | Order and Referring Only - Dentist |
0840588828 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5284 | OK | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Long Branch Dental Group, del G. Gregory, D.D.S., PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2002023192 | MO | Yes |
| General Practice Dentistry | 1223G0001X | 5284 | OK |
Addresses
Primary practice location
1609 Maffry Ave
Macon, MO 63552-1960
Mailing address
301 Karat Place
Macon, MO 63552-4144
Phone (660) 385-3413
Other providers in Macon, MO
- Macon County Sheltered Workshop
- Macon Rehabilitation Services, LLC
- Mark Vincent Maddox
- Donet Christopher Main
- Jessica March
- Matthew Theriac, D.D.S. LLC
- Lisa Michelle Mayes
- Shaylyn McCollough
- James W McDowell
- McPherson Medical & Diagnostic LLC
All providers in Macon, MO · General Practice Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.