Provider Demographics
NPI:1265517593
Name:MARSH, DANIEL L (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:MARSH
Suffix:
Gender:M
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:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552
Mailing Address - Country:US
Mailing Address - Phone:715-762-3409
Mailing Address - Fax:715-762-3073
Practice Address - Street 1:1001 N FIRST AVENUE
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552
Practice Address - Country:US
Practice Address - Phone:715-762-3409
Practice Address - Fax:715-762-3073
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1870G122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33362800Medicaid
WI33362800Medicare ID - Type Unspecified