Healthcare Provider Details

I. General information

NPI: 1699863795
Provider Name (Legal Business Name): MARK L. PLEDGER, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41011 CALIFORNIA OAKS RD SUITE 102
MURRIETA CA
92562-5751
US

IV. Provider business mailing address

41011 CALIFORNIA OAKS RD SUITE 102
MURRIETA CA
92562-5751
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: DR. MARK L. PLEDGER
Title or Position: OWNER
Credential: DDS, INC.
Phone: 951-600-1333