Provider Demographics
NPI:1477524411
Name:NAISBITT, MARK A (DDS, MS ORTHODONTICS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:NAISBITT
Suffix:
Gender:M
Credentials:DDS, MS ORTHODONTICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E SOUTH TEMPLE
Mailing Address - Street 2:#312 - MONARCH DENTAL ADMINISTRATION OFFICE
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1319
Mailing Address - Country:US
Mailing Address - Phone:801-220-0940
Mailing Address - Fax:801-220-0139
Practice Address - Street 1:420 E SOUTH TEMPLE
Practice Address - Street 2:#312 - MONARCH DENTAL ADMINISTRATION OFFICE
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1319
Practice Address - Country:US
Practice Address - Phone:801-220-0940
Practice Address - Fax:801-220-0139
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-29
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8036426-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics