Individual provider Active NPI

Amanda Kristen Marshall, DMD

  • General Practice Dentistry
  • Flagstaff, AZ
National Provider Identifier
1861380511
Registry record updated May 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12985 Issued in TN
Practice address
2920 N 4TH St
Flagstaff, AZ 86004-1816
Phone
(928) 522-9400
NPI assigned
Jun 24, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D012536 AZ
General Practice Dentistry 1223G0001X 12985 TN Primary

Addresses

Primary practice location

2920 N 4TH St
Flagstaff, AZ 86004-1816

Mailing address

2920 N 4TH St
Flagstaff, AZ 86004-1816

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20251117001763 TN Practitioner - Dentist 2567953615 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
At Still University, Arizona School of Dentistry & Oral HLTH, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1200 Synergy Way
Holly Hill, FL 32117-2502

1923 Sulphur Springs Rd
Morristown, TN 37813-5654

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D012536AZMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Cherokee Health Systems CurrentSince Nov 6, 2025 Accepting new patients
Cherokee Health Systems CurrentSince Nov 6, 2025 Accepting new patients

Locations

255 E Watt St
Alcoa, TN 37701
Phone (865) 273-1616

2018 Western Ave
Knoxville, TN 37921
Phone (865) 544-0406

5500 Creekwood Park Blvd
Lenoir City, TN 37772
Phone (865) 986-8082

4330 Maynardville Hwy
Maynardville, TN 37807
Phone (865) 992-3849

1923 Sulphur Springs Rd
Morristown, TN 37813

6350 W Andrew Johnson Hwy
#100
Talbott, TN 37877
Phone (423) 586-5031

6350 W Andrew Johnson Hwy
Talbott, TN 37877
Phone (423) 586-5031

Organizations & group practices 2

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": "1750723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779321600000",
    "number": "1861380511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 N 4TH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 N 4TH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041816",
            "telephone_number": "928-522-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "AMANDA",
        "middle_name": "KRISTEN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-24",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D012536",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "12985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.