Healthcare Provider Details

I. General information

NPI: 1184553182
Provider Name (Legal Business Name): MARK DYLAN KOVAR DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 FAIR OAKS BLVD
CARMICHAEL CA
95608-4019
US

IV. Provider business mailing address

1194 SOMERSWORTH LN
LINCOLN CA
95648-3263
US

V. Phone/Fax

Practice location:
  • Phone: 916-487-7148
  • Fax:
Mailing address:
  • Phone: 817-688-7091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK DYLAN KOVAR
Title or Position: OWNER
Credential: DMD
Phone: 817-688-7091