Provider Demographics
NPI:1083821458
Name:DEAL, MARK E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:DEAL
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 1:1625 SUNNYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-9264
Mailing Address - Country:US
Mailing Address - Phone:574-534-5528
Mailing Address - Fax:574-534-8146
Practice Address - Street 1:1625 SUNNYFIELD DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-9264
Practice Address - Country:US
Practice Address - Phone:574-534-5528
Practice Address - Fax:574-534-8146
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120101081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice