Provider Demographics
NPI:1023025442
Name:BUDKE, MARK W (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:BUDKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9312 WINTON RD
Mailing Address - Street 2:STE. 2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3938
Mailing Address - Country:US
Mailing Address - Phone:513-931-4524
Mailing Address - Fax:513-931-4632
Practice Address - Street 1:9312 WINTON RD
Practice Address - Street 2:STE. 2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3938
Practice Address - Country:US
Practice Address - Phone:513-931-4524
Practice Address - Fax:513-931-4632
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0158451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice