Organization
TRADEMARK DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYLER ROBB DDS (OWNER)
(208) 278-9900
Entity
Organization
Contact information
Practice address
115 N. PLYMOUTH AVE., NEW PLYMOUTH, ID 83655
(208) 278-9900
Mailing address
PO BOX 3, NEW PLYMOUTH, ID 83655-0003
(208) 278-9900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4158
ID
1223G0001X
General Practice Dentistry
D9152
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164682704
PERSONAL NPI
—
05
—
9211402
—
ID
Enumeration date
11/09/2010
Last updated
11/09/2010
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