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General NPI Number Information
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NPI Number | 1346714821
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Entity Type | Organization
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Legal Business Name | MARQUETTE FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 301 W MAGNETIC ST
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City | MARQUETTE
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State | MI
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Zip | 49855-2708
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Country | US
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Telephone | 906-228-9333
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Fax | 906-661-2037
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Provider Business Mailing Address
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Address Line | 301 W MAGNETIC ST
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City | MARQUETTE
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State | MI
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Zip | 49855-2708
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Country | US
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Telephone | 906-228-9333
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Fax | 906-661-2037
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Authorized Official
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Title or Position | DOCTOR- OWNER
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Name | DR. KYLE BLAU
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Credential | DDS
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Telephone | 906-228-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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