Provider Demographics
NPI:1083757413
Name:PAGANINI, MARK W I (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:PAGANINI
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1080 S VAN DYKE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9635
Mailing Address - Country:US
Mailing Address - Phone:989-269-9769
Mailing Address - Fax:989-269-8778
Practice Address - Street 1:1080 S VAN DYKE RD
Practice Address - Street 2:SUITE C
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9635
Practice Address - Country:US
Practice Address - Phone:989-269-9769
Practice Address - Fax:989-269-8778
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI142641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice