Individual
MARK MARLOWE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2805 EAGLE DR, AMMON, ID 83406-5769
(208) 542-1333
(208) 552-7296
Mailing address
2805 EAGLE DR, AMMON, ID 83406-5769
(208) 542-1333
(208) 552-7296
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D-3893-PD
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807208500
—
ID
Enumeration date
04/26/2007
Last updated
04/02/2024
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