Provider Demographics
NPI:1518020825
Name:DAVIS, MARK S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1761 S NAPERVILLE RD
Mailing Address - Street 2:105
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5846
Mailing Address - Country:US
Mailing Address - Phone:630-668-6180
Mailing Address - Fax:630-668-6441
Practice Address - Street 1:1761 S NAPERVILLE RD
Practice Address - Street 2:105
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5846
Practice Address - Country:US
Practice Address - Phone:630-668-6180
Practice Address - Fax:630-668-6441
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL019-0191011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice