Provider Demographics
NPI:1164529301
Name:MARK L DIRE DDS P.S.
Entity Type:Organization
Organization Name:MARK L DIRE DDS P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-747-8052
Mailing Address - Street 1:12917 S.E. 38TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006
Mailing Address - Country:US
Mailing Address - Phone:425-747-8052
Mailing Address - Fax:425-562-7222
Practice Address - Street 1:12917 S.E. 38TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006
Practice Address - Country:US
Practice Address - Phone:425-747-8052
Practice Address - Fax:425-562-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty