Provider Demographics
NPI:1174675276
Name:SAPERSTEIN, MARK KALEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:KALEN
Last Name:SAPERSTEIN
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 1:6619 N 19TH AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1631
Mailing Address - Country:US
Mailing Address - Phone:602-249-0961
Mailing Address - Fax:602-249-1128
Practice Address - Street 1:6619 N 19TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1631
Practice Address - Country:US
Practice Address - Phone:602-249-0961
Practice Address - Fax:602-249-1128
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD16611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice