| 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 |