Provider Demographics
NPI:1518697275
Name:MARKS, DAWN (NAIL TECH)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:NAIL TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 SUMMERLINN DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-5110
Mailing Address - Country:US
Mailing Address - Phone:503-997-3703
Mailing Address - Fax:
Practice Address - Street 1:4105 SUMMERLINN DR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-5110
Practice Address - Country:US
Practice Address - Phone:503-997-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCOS-CI-10177944247200000X, 261QP1100X, 246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty