Provider Demographics
NPI:1043728173
Name:HENSHAW MARBLE, MICHELLE MARIE (DDS, MPH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:HENSHAW MARBLE
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:HENSHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MPH
Mailing Address - Street 1:74 N WALKER ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:560 HARRISON AVE STE 302
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2884
Practice Address - Country:US
Practice Address - Phone:617-638-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186981223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health