MEDICARE: DR. MARK W BUDKE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30.015845	OH

General Provider Information

NPI Number	:	1023025442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK W BUDKE D.D.S.

Provider Business Mailing Address
First Line	:	9312 WINTON RD
Second Line	:	STE. 2
City	:	CINCINNATI
State	:	OH
Zip	:	45231-3938
Country	:	US
Telephone Number	:	513-931-4524
Fax Number	:	513-931-4632

Provider Business Practice Location Address
First Line	:	9312 WINTON RD
Second Line	:	STE. 2
City	:	CINCINNATI
State	:	OH
Zip	:	45231-3938
Country	:	US
Telephone Number	:	513-931-4524
Fax Number	:	513-931-4632

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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