Provider Demographics
NPI:1457473134
Name:SVORE, MARK C (DDS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:C
Last Name:SVORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:2611 NE 125TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4373
Mailing Address - Country:US
Mailing Address - Phone:206-363-3240
Mailing Address - Fax:206-361-4869
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-363-3240
Practice Address - Fax:206-361-4869
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA48911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5560404Medicaid
WA5664OtherWASHINTON DENTAL SERVICE