Provider Demographics
NPI:1235178443
Name:NEARING, MARK VINCENT (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:VINCENT
Last Name:NEARING
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 1:400 W MAIN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1876
Mailing Address - Country:US
Mailing Address - Phone:989-731-6741
Mailing Address - Fax:
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1876
Practice Address - Country:US
Practice Address - Phone:989-731-6741
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010170791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics