Provider Demographics
NPI:1518017995
Name:KOURIS, MARK A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:KOURIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:27660 MARGUERITE PKWY
Mailing Address - Street 2:3A
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-3606
Mailing Address - Country:US
Mailing Address - Phone:949-364-2222
Mailing Address - Fax:949-364-2240
Practice Address - Street 1:27660 MARGUERITE PKWY
Practice Address - Street 2:3A
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3606
Practice Address - Country:US
Practice Address - Phone:949-364-2222
Practice Address - Fax:949-364-2240
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice