Provider Demographics
NPI:1437460219
Name:ARMSTRONG, MARK WANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WANE
Last Name:ARMSTRONG
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 1:154 COCHRANE PLZ
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-2812
Mailing Address - Country:US
Mailing Address - Phone:408-778-4838
Mailing Address - Fax:408-778-4879
Practice Address - Street 1:154 COCHRANE PLZ
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-2812
Practice Address - Country:US
Practice Address - Phone:408-778-4838
Practice Address - Fax:408-778-4879
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist