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General NPI Number Information
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NPI Number | 1902091382
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Entity Type | Individual
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Provider Name | DEAN ROBERT CARLYON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 1960 US HWY 41 SOUTH MARQUETTE PRISON
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City | MARQUETTE
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State | MI
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Zip | 49855
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Country | US
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Telephone | 906-226-6531
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Fax | 906-226-1972
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Provider Business Mailing Address
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Address Line | PO BOX 96
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City | MARQUETTE
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State | MI
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Zip | 49855-0096
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Country | US
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Telephone | 906-343-6776
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Fax | 906-226-1972
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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 | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 5315004921
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License Number State | MI
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