Provider Demographics
NPI:1437200854
Name:AN, MARK W (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:AN
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:11811 MUKILTEO SPEEDWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5442
Mailing Address - Country:US
Mailing Address - Phone:425-267-9900
Mailing Address - Fax:425-267-9901
Practice Address - Street 1:11811 MUKILTEO SPEEDWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5442
Practice Address - Country:US
Practice Address - Phone:425-267-9900
Practice Address - Fax:425-267-9901
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WADE000104561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5050968Medicaid