NPI | 1710785100 |
---|---|
Doing Business As | STATELINE DENTAL |
Entity Type | Organization |
Authorized Contact | TYLER KENT MARLOWE Owner/Operator 208-881-7963 |
Organization Subpart ? | No |
Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
Enumeration Date | 2025-03-03 |
Last Update Date | 2025-03-03 |