Provider Demographics
NPI:1558370213
Name:MARLOW, MARIETTA CANTY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:MARIETTA
Middle Name:CANTY
Last Name:MARLOW
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NW OAK AVE
Mailing Address - Street 2:
Mailing Address - City:CACHE
Mailing Address - State:OK
Mailing Address - Zip Code:73527-9268
Mailing Address - Country:US
Mailing Address - Phone:580-429-3673
Mailing Address - Fax:
Practice Address - Street 1:1315 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3605
Practice Address - Country:US
Practice Address - Phone:580-585-5607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2216124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist