Provider Demographics
NPI:1720148778
Name:POMELOW, MARLENA L (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARLENA
Middle Name:L
Last Name:POMELOW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14938 SAN PASQUAL
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023
Mailing Address - Country:US
Mailing Address - Phone:210-801-9551
Mailing Address - Fax:888-431-1817
Practice Address - Street 1:14938 SAN PASQUAL
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023
Practice Address - Country:US
Practice Address - Phone:210-801-9551
Practice Address - Fax:888-431-1817
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice