Provider Demographics
NPI:1265649784
Name:AYCOCK, MARK W (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:AYCOCK
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 1:2539 S GESSNER RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-2034
Mailing Address - Country:US
Mailing Address - Phone:713-953-0010
Mailing Address - Fax:
Practice Address - Street 1:2539 S GESSNER RD
Practice Address - Street 2:SUITE 16
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2034
Practice Address - Country:US
Practice Address - Phone:713-953-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11,4011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice