Provider Demographics
NPI:1710473814
Name:MARLOR, JEFF THOMAS (DMD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:THOMAS
Last Name:MARLOR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1070
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446-1070
Mailing Address - Country:US
Mailing Address - Phone:970-887-3832
Mailing Address - Fax:970-887-3925
Practice Address - Street 1:290 E AGATE AVENUE
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446
Practice Address - Country:US
Practice Address - Phone:970-887-3832
Practice Address - Fax:970-887-3925
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002036861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice