MEDICARE: DR. MARK DAVID ESSNER 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	1223E0200X	Endodontics	6517	NE

General Provider Information

NPI Number	:	1982793923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK DAVID ESSNER DDS

Provider Business Mailing Address
First Line	:	15750 W DODGE RD STE 303
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-2535
Country	:	US
Telephone Number	:	855-965-3636
Fax Number	:	877-366-0329

Provider Business Practice Location Address
First Line	:	15750 W DODGE RD STE 303
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-2535
Country	:	US
Telephone Number	:	855-965-3636
Fax Number	:	877-366-0329

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/26/2011

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