Provider Demographics
NPI:1386855260
Name:MARDOCK, JOHN ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:MARDOCK
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 1:717 STRAUS RD
Mailing Address - Street 2:P.O. BOX 1092
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1785
Mailing Address - Country:US
Mailing Address - Phone:972-291-5422
Mailing Address - Fax:972-291-5445
Practice Address - Street 1:717 STRAUS RD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1785
Practice Address - Country:US
Practice Address - Phone:972-291-5422
Practice Address - Fax:972-291-5445
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice