Provider Demographics
NPI:1215821947
Name:MARINO, KALYN (DMD)
Entity type:Individual
Prefix:
First Name:KALYN
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KALYN
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5258 S MICHIGAN AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2996
Mailing Address - Country:US
Mailing Address - Phone:417-239-4251
Mailing Address - Fax:
Practice Address - Street 1:540 W LASALLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4799
Practice Address - Country:US
Practice Address - Phone:417-887-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025022366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist