Provider Demographics
NPI:1568543734
Name:GEDDES, MARK COOK (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:COOK
Last Name:GEDDES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 33RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1381
Mailing Address - Country:US
Mailing Address - Phone:801-394-4415
Mailing Address - Fax:801-394-3212
Practice Address - Street 1:1220 33RD ST STE B
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1381
Practice Address - Country:US
Practice Address - Phone:801-394-4415
Practice Address - Fax:801-394-3212
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5145132-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1426484OtherUNITED CONCORDIA