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General NPI Number Information
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NPI Number | 1215821947
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Entity Type | Individual
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Provider Name | KALYN MARINO DMD
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Gender | Female
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 540 W LASALLE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65807-4799
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Country | US
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Telephone | 417-887-1220
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Fax |
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Provider Business Mailing Address
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Address Line | 5258 S MICHIGAN AVE APT 102
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City | SPRINGFIELD
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State | MO
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Zip | 65810-2996
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Country | US
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Telephone | 417-239-4251
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2025022366
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License Number State | MO
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