Provider Demographics
NPI:1053484956
Name:SILLS, MARK FRANKLIN (DDS PC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:FRANKLIN
Last Name:SILLS
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:602 HOOSIER AVE
Mailing Address - City:OOLITIC
Mailing Address - State:IN
Mailing Address - Zip Code:47451
Mailing Address - Country:US
Mailing Address - Phone:812-279-2022
Mailing Address - Fax:812-277-9915
Practice Address - Street 1:602 HOOSIER AVE
Practice Address - Street 2:
Practice Address - City:OOLITIC
Practice Address - State:IN
Practice Address - Zip Code:47451
Practice Address - Country:US
Practice Address - Phone:812-279-2022
Practice Address - Fax:812-277-9915
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120097811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice