Provider Demographics
NPI:1245254663
Name:STORM, MARSHALL A (DDS)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:A
Last Name:STORM
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 1:841 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2997
Mailing Address - Country:US
Mailing Address - Phone:508-668-1766
Mailing Address - Fax:508-668-0308
Practice Address - Street 1:841 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2997
Practice Address - Country:US
Practice Address - Phone:508-668-1766
Practice Address - Fax:508-668-0308
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA188961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice