Individual
JUSTIN KENNETH MARRIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
(DDS)
Contact information
Practice address
309 SW 59TH ST, #105, OKLAHOMA CITY, OK 73109-8321
(405) 631-2700
Mailing address
201 W 8TH ST, SUITE 810, PUEBLO, CO 81003-3038
(719) 562-4447
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7439272-9921
UT
Other
Enumeration date
09/30/2009
Last updated
02/17/2011
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