Provider Demographics
NPI:1114050077
Name:MCCARTHY, MARK LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LYNN
Last Name:MCCARTHY
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 1:2900 CENTRAL AVE BLDG 1
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-8626
Mailing Address - Country:US
Mailing Address - Phone:406-656-6100
Mailing Address - Fax:406-656-8726
Practice Address - Street 1:2900 CENTRAL AVE BLDG 1
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-8626
Practice Address - Country:US
Practice Address - Phone:406-656-6100
Practice Address - Fax:406-656-8726
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0143021223G0001X
MTDEN-DEN-LIC 115741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice