Provider Demographics
NPI:1346714821
Name:MARQUETTE FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:MARQUETTE FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR- OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:906-228-9333
Mailing Address - Street 1:301 W MAGNETIC ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2708
Mailing Address - Country:US
Mailing Address - Phone:906-228-9333
Mailing Address - Fax:906-661-2037
Practice Address - Street 1:301 W MAGNETIC ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2708
Practice Address - Country:US
Practice Address - Phone:906-228-9333
Practice Address - Fax:906-661-2037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental