Healthcare Provider Details

I. General information

NPI: 1306917406
Provider Name (Legal Business Name): MARK MAMARI DDS. PSC. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 CHELSEA DR
FT MITCHELL KY
41017-1701
US

IV. Provider business mailing address

2503 CHELSEA DR
FT MITCHELL KY
41017-1701
US

V. Phone/Fax

Practice location:
  • Phone: 859-426-9666
  • Fax:
Mailing address:
  • Phone: 859-426-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number7221
License Number StateKY

VIII. Authorized Official

Name: DR. MARK MAMARI
Title or Position: DR.
Credential: DDS
Phone: 859-426-9666