Provider Demographics
NPI:1043409287
Name:MAREK, MIKE L (DDS)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:L
Last Name:MAREK
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 1:3506 HWY 6 SOUTH
Mailing Address - Street 2:#142
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4401
Mailing Address - Country:US
Mailing Address - Phone:281-980-2500
Mailing Address - Fax:281-494-9404
Practice Address - Street 1:1111 HWY 6 SOUTH
Practice Address - Street 2:STE 220
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-980-2500
Practice Address - Fax:281-494-9404
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist