Provider Demographics
NPI:1093813487
Name:FRANCUCK, MARK CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHARLES
Last Name:FRANCUCK
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 1:8619 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2384
Mailing Address - Country:US
Mailing Address - Phone:810-227-7059
Mailing Address - Fax:810-227-3562
Practice Address - Street 1:8619 W GRAND RIVER AVE
Practice Address - Street 2:SUITE E
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2384
Practice Address - Country:US
Practice Address - Phone:810-227-7059
Practice Address - Fax:810-227-3562
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI139341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice