Provider Demographics
NPI:1437408630
Name:VORHIES, MARK ALLAN (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLAN
Last Name:VORHIES
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 1:1678 FRY RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1175
Mailing Address - Country:US
Mailing Address - Phone:317-887-1288
Mailing Address - Fax:317-889-2515
Practice Address - Street 1:1678 FRY ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1175
Practice Address - Country:US
Practice Address - Phone:317-887-1288
Practice Address - Fax:317-889-2515
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7743122300000X
IN120077431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics