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General NPI Number Information
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NPI Number | 1740074616
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Entity Type | Organization
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Legal Business Name | TYLER KENT MARLOWE DDS PLLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 1246 YELLOWSTONE AVE STE D3
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City | POCATELLO
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State | ID
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Zip | 83201-4373
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Country | US
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Telephone | 208-881-7963
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Fax |
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Provider Business Mailing Address
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Address Line | 519 S 19TH AVE
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City | POCATELLO
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State | ID
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Zip | 83201-3462
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. TYLER KENT MARLOWE
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Credential | DDS
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Telephone | 208-881-7963
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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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