Provider Demographics
NPI:1225098536
Name:FRILL, MARK C (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:FRILL
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 1:10732 VIRGINIA PLZ
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128
Mailing Address - Country:US
Mailing Address - Phone:402-991-7980
Mailing Address - Fax:402-509-1578
Practice Address - Street 1:10732 VIRGINIA PLZ
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128
Practice Address - Country:US
Practice Address - Phone:402-991-7980
Practice Address - Fax:402-509-1578
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice