MEDICARE: DR. MARK A NAISBITT DDS, MS ORTHODONTICS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	8036426-9921	UT

General Provider Information

NPI Number	:	1477524411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A NAISBITT DDS, MS ORTHODONTICS

Provider Business Mailing Address
First Line	:	420 E SOUTH TEMPLE
Second Line	:	#312 - MONARCH DENTAL ADMINISTRATION OFFICE
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1319
Country	:	US
Telephone Number	:	801-220-0940
Fax Number	:	801-220-0139

Provider Business Practice Location Address
First Line	:	420 E SOUTH TEMPLE
Second Line	:	#312 - MONARCH DENTAL ADMINISTRATION OFFICE
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1319
Country	:	US
Telephone Number	:	801-220-0940
Fax Number	:	801-220-0139

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

Provider Enumeration Date	:	01/29/2006
Last Update Date	:	11/08/2012

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