Healthcare Provider Details

I. General information

NPI: 1205845831
Provider Name (Legal Business Name): DAVID N MARKS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 E 98TH ST STE 121
INDIANAPOLIS IN
46280-1973
US

IV. Provider business mailing address

4901 ESSEX DR
CARMEL IN
46033-9600
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-0067
  • Fax: 317-844-0527
Mailing address:
  • Phone: 317-848-2823
  • Fax: 317-844-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7266
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: