Provider Demographics
NPI:1407827975
Name:CADOTTE, MARK GERARD (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GERARD
Last Name:CADOTTE
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 1:2112 FANTASY LANE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7412
Mailing Address - Country:US
Mailing Address - Phone:989-798-0539
Mailing Address - Fax:989-832-4383
Practice Address - Street 1:720 W WACKERLY
Practice Address - Street 2:STE 9
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2769
Practice Address - Country:US
Practice Address - Phone:989-832-8881
Practice Address - Fax:989-832-4383
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI124611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice