Healthcare Provider Details

I. General information

NPI: 1659399285
Provider Name (Legal Business Name): MARK L PLEDGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41011 CALIFORNIA OAKS RD. SUITE 102
MURRIETA CA
92562
US

IV. Provider business mailing address

41011 CALIFORNIA OAKS RD. SUITE 102
MURRIETA CA
92562
US

V. Phone/Fax

Practice location:
  • Phone: 951-600-1333
  • Fax: 951-600-1782
Mailing address:
  • Phone: 951-600-1333
  • Fax: 951-600-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number41520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: