Active NPI
Marlin Dwayne Peace, DDS
- General Practice Dentistry
- Tyler, TX
National Provider Identifier
1558417253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 14232
- Practice address
- 300 E 5TH St
Tyler, TX 75701-4225 - Phone
- (903) 592-1992
- Fax
- (903) 592-6401
- NPI assigned
- Jan 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 14232 | TX | Primary |
Addresses
Primary practice location
300 E 5TH St
Tyler, TX 75701-4225
Mailing address
300 E 5TH St
Tyler, TX 75701-4225
Phone (903) 592-1992
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14232 | TX | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1558417253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 E 5TH ST",
"city": "TYLER",
"state": "TX",
"postal_code": "757014225",
"telephone_number": "903-592-1992",
"fax_number": "903-592-6401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 E 5TH ST",
"city": "TYLER",
"state": "TX",
"postal_code": "757014225",
"telephone_number": "903-592-1992",
"fax_number": "903-592-6401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEACE",
"first_name": "MARLIN",
"middle_name": "DWAYNE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "14232",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.