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NPI Code Detail

MEDICARE: DR. MARK DOUGLAS TEIGEN D.D.S.

MEDICARE: DR. MARK DOUGLAS TEIGEN D.D.S.
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
11223G0001XGeneral Practice DentistryDE0007669WA

General Provider Information

NPI Number : 1851504757
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK DOUGLAS TEIGEN D.D.S.
Provider Business Mailing Address
First Line : 4818B SHE NAH NUM DR SE
Second Line :
City : OLYMPIA
State : WA
Zip : 98513-9105
Country : US
Telephone Number : 360-459-5132
Fax Number :
Provider Business Practice Location Address
First Line : 4818B SHE NAH NUM DR SE
Second Line :
City : OLYMPIA
State : WA
Zip : 98513-9105
Country : US
Telephone Number : 360-459-5312
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2007
Last Update Date : 05/17/2011

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