# TRADEMARK DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861793796
- **Authorized official:** DR. TYLER ROBB DDS (OWNER)
- **Authorized official phone:** (208) 278-9900

## Contact information

- **Practice address:** 115 N. PLYMOUTH AVE., NEW PLYMOUTH, ID 83655
- **Practice address phone:** (208) 278-9900
- **Mailing address:** PO BOX 3, NEW PLYMOUTH, ID 83655-0003
- **Mailing address phone:** (208) 278-9900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D4158 | ID | Yes |
| 1223G0001X | General Practice Dentistry | D9152 | OR | — |

## Other

- **Enumeration date:** 11/09/2010
- **Last updated:** 11/09/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1164682704 | PERSONAL NPI | — |
| 05 | — | 9211402 | — | ID |