Provider Demographics
NPI:1205036944
Name:KAHN, MARK BARRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BARRY
Last Name:KAHN
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 1:1645 ROUTE 112
Mailing Address - Street 2:SUITE A
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3635
Mailing Address - Country:US
Mailing Address - Phone:631-289-1555
Mailing Address - Fax:631-289-1545
Practice Address - Street 1:1645 ROUTE 112
Practice Address - Street 2:SUITE A
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3635
Practice Address - Country:US
Practice Address - Phone:631-289-1555
Practice Address - Fax:631-289-1545
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist