MEDICARE: MR. MARK EDWARD STUDER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	14578	TX

General Provider Information

NPI Number	:	1114089422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK EDWARD STUDER DDS

Provider Business Mailing Address
First Line	:	1256 HARWOOD RD
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-4244
Country	:	US
Telephone Number	:	817-545-4040
Fax Number	:	817-545-0373

Provider Business Practice Location Address
First Line	:	1256 HARWOOD RD
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-4244
Country	:	US
Telephone Number	:	817-545-4040
Fax Number	:	817-545-0373

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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