Provider Demographics
NPI:1164563516
Name:PASTERNAK, MARK R (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:PASTERNAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 INVERNESS DR E
Mailing Address - Street 2:#230
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5138
Mailing Address - Country:US
Mailing Address - Phone:303-792-9904
Mailing Address - Fax:303-792-9907
Practice Address - Street 1:125 INVERNESS DR E
Practice Address - Street 2:#230
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5138
Practice Address - Country:US
Practice Address - Phone:303-792-9904
Practice Address - Fax:303-792-9907
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6182122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist