Lynne Leslie Marshall, DMD
Individual provider Active NPI General Practice Dentistry · Bourne, MA
NPI 1821005679 · NPPES record last updated Jan 17, 2008
Key facts
- NPI
- 1821005679
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 15197 (MA)
- Practice address
- 1 Trowbridge Rd
Bourne, MA 02532 - Phone
- (508) 759-7200
- Fax
- (508) 759-7219
- NPI assigned
- Aug 2, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- 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 |
|---|---|---|---|---|
| I20150512000117 | MA | Order and Referring Only - Dentist |
1759600869 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15197 | MA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 15197 | MA | Yes |
Addresses
Primary practice location
1 Trowbridge Rd
Bourne, MA 02532
Mailing address
1 Trowbridge Rd
Bourne, MA 02532-3660
Phone (508) 759-7200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| X11722 | Other | MA | BLUE CROSS BLUE SHIELD |
NPI Registry JSON
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200528000000",
"number": "1821005679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 TROWBRIDGE RD",
"city": "BOURNE",
"state": "MA",
"postal_code": "025323660",
"telephone_number": "508-759-7200",
"fax_number": "508-759-7219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 TROWBRIDGE RD",
"city": "BOURNE",
"state": "MA",
"postal_code": "02532",
"telephone_number": "508-759-7200",
"fax_number": "508-759-7219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALL",
"first_name": "LYNNE",
"middle_name": "LESLIE",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-02",
"last_updated": "2008-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "15197",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "X11722",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bourne, MA
- Nancy Jean Lisi
- Casey Jacqueline Lynch
- Caitlin L. Mann
- Stephanie L Marceau
- Xavier Marquez
- Pamela J Matthews
- Mazdenta Advanced Dentistry PLLC
- Jennifer McCarthy
- Emily Meschwitz
- Emily Mason Michael
All providers in Bourne, MA · General Practice Dentistry in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2008. 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.