MEDICARE: MARK J. MECKES, DDS, INC.

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	43371	CA

General Provider Information

NPI Number	:	1700974615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK J. MECKES, DDS, INC.

Provider Business Mailing Address
First Line	:	5580 E 2ND ST
Second Line	:	SUITE 207
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3946
Country	:	US
Telephone Number	:	562-438-9994
Fax Number	:

Provider Business Practice Location Address
First Line	:	5580 E 2ND ST
Second Line	:	SUITE 207
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3946
Country	:	US
Telephone Number	:	562-438-9994
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK JAMES MECKES
Credential	:	D.D.S.
Telephone Number	:	562-438-9994

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	04/02/2013

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