Provider Demographics
NPI:1245223122
Name:EHRHARDT, MARK STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:EHRHARDT
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 1:2700 E BRIDGE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2591
Mailing Address - Country:US
Mailing Address - Phone:303-659-1825
Mailing Address - Fax:303-637-9547
Practice Address - Street 1:2700 E BRIDGE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2591
Practice Address - Country:US
Practice Address - Phone:303-659-1825
Practice Address - Fax:303-637-9547
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO64811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice