Provider Demographics
NPI:1043882491
Name:MARSHALL, ELIZABETH LAURA (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LAURA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PALMETTO LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN SHORES
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3720
Mailing Address - Country:US
Mailing Address - Phone:336-317-0238
Mailing Address - Fax:
Practice Address - Street 1:3704 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-9256
Practice Address - Country:US
Practice Address - Phone:252-261-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice