Healthcare Provider Details

I. General information

NPI: 1982710224
Provider Name (Legal Business Name): JEFFREY BRUCE MARKS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10241 GREENWOOD AVE N
SEATTLE WA
98133-9141
US

IV. Provider business mailing address

10241 GREENWOOD AVE N
SEATTLE WA
98133-9141
US

V. Phone/Fax

Practice location:
  • Phone: 206-789-4035
  • Fax: 206-789-3541
Mailing address:
  • Phone: 206-789-4035
  • Fax: 206-789-3541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDE00009477
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: