Provider Demographics
NPI:1275547671
Name:BINGHAM, MARK HOWARD (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:HOWARD
Last Name:BINGHAM
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 1:6007 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136
Mailing Address - Country:US
Mailing Address - Phone:206-937-5510
Mailing Address - Fax:206-937-5511
Practice Address - Street 1:6007 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136
Practice Address - Country:US
Practice Address - Phone:206-937-5510
Practice Address - Fax:206-937-5511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist