Healthcare Provider Details

I. General information

NPI: 1538358189
Provider Name (Legal Business Name): MARK D. POGUE, M.D. D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8535 E HARTFORD DR STE 100
SCOTTSDALE AZ
85255-5443
US

IV. Provider business mailing address

8535 E HARTFORD DR STE 100
SCOTTSDALE AZ
85255-5443
US

V. Phone/Fax

Practice location:
  • Phone: 480-515-5400
  • Fax: 480-515-5493
Mailing address:
  • Phone: 480-515-5400
  • Fax: 480-515-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number26467
License Number StateAZ

VIII. Authorized Official

Name: MARK D POGUE
Title or Position: PRESIDENT
Credential:
Phone: 480-515-5400