Provider Demographics
NPI:1568539229
Name:MORIN, MARK ROLLAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROLLAND
Last Name:MORIN
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 1:19178 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2445
Mailing Address - Country:US
Mailing Address - Phone:248-354-1555
Mailing Address - Fax:248-354-3331
Practice Address - Street 1:19178 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2445
Practice Address - Country:US
Practice Address - Phone:248-354-1555
Practice Address - Fax:248-354-3331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI14117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist