MEDICARE: MR. MARK A. EASTMAN D.D.S.,P.C.

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	122300000X	Dentist	14252	MI

General Provider Information

NPI Number	:	1043619463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK A. EASTMAN D.D.S.,P.C.

Provider Business Mailing Address
First Line	:	5301 FENTON RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-4034
Country	:	US
Telephone Number	:	810-233-5361
Fax Number	:	810-233-7952

Provider Business Practice Location Address
First Line	:	5301 FENTON RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-4034
Country	:	US
Telephone Number	:	810-233-5361
Fax Number	:	810-233-7952

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

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	08/21/2014

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