Provider Demographics
NPI:1497117402
Name:OPPENHEIM, MARK A (DMD, MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:OPPENHEIM
Suffix:
Gender:M
Credentials:DMD, MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1500 W UNIVERSITY AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-7109
Mailing Address - Country:US
Mailing Address - Phone:518-852-0884
Mailing Address - Fax:
Practice Address - Street 1:5246 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3513
Practice Address - Country:US
Practice Address - Phone:254-773-4444
Practice Address - Fax:254-773-4444
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX38174204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery