Individual
DR. DANIEL TYLER MARVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4000 CENTRAL AVE NE, SUITE 308, COLUMBIA HEIGHTS, MN 55421-2968
(763) 781-7475
(763) 781-0828
Mailing address
16992 73RD PL N, MAPLE GROVE, MN 55311-2681
(763) 425-3078
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9473
MN
Other
Enumeration date
12/07/2006
Last updated
08/23/2007
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