=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184553182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK DYLAN KOVAR DMD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2026
-----------------------------------------------------
Last Update Date | 05/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6440 FAIR OAKS BLVD
-----------------------------------------------------
City | CARMICHAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95608-4019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-487-7148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1194 SOMERSWORTH LN
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95648-3263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-688-7091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARK DYLAN KOVAR
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 817-688-7091
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------