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General NPI Number Information
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NPI Number | 1528270634
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Entity Type | Individual
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Provider Name | MARK WILLIAM BOTTORFF DDS
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 323 S. GREENRIDGE DR.
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City | LIBERTY LAKE
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State | WA
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Zip | 99019
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Country | US
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Telephone | 509-808-9766
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Fax | 509-891-8999
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Provider Business Mailing Address
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Address Line | 1324 N. LIBERTY LAKE RD STE 345
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City | LIBERTY LAKE
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State | WA
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Zip | 99019
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Country | US
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Telephone | 509-808-9766
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Fax | 509-891-8999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | GA10000366
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | DE00009793
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License Number State | WA
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