Provider Demographics
NPI:1497840581
Name:FAULKNER, MARK COLLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:COLLEN
Last Name:FAULKNER
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 1:5416 SOUTH YALE
Mailing Address - Street 2:SUITE # 125
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6239
Mailing Address - Country:US
Mailing Address - Phone:918-496-1100
Mailing Address - Fax:
Practice Address - Street 1:5416 SOUTH YALE
Practice Address - Street 2:SUITE # 125
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6239
Practice Address - Country:US
Practice Address - Phone:918-496-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice