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General NPI Number Information
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NPI Number | 1295305654
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Entity Type | Individual
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Provider Name | TYLER JUSTIN MARRIOTT DDS
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Gender | Male
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 10/23/2021
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Provider Practice Location Address
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Address Line | 8142 TEZEL RD
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City | SAN ANTONIO
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State | TX
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Zip | 78250-3032
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Country | US
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Telephone | 210-852-2003
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Fax |
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Provider Business Mailing Address
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Address Line | 7838 HUEBNER RD APT 3204
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City | SAN ANTONIO
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State | TX
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Zip | 78240-6125
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Country | US
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Telephone | 956-821-4688
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 37645
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License Number State | TX
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