Provider Demographics
NPI:1578770970
Name:ZIEGLER, MARK WADE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WADE
Last Name:ZIEGLER
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:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:BATTIEST
Mailing Address - State:OK
Mailing Address - Zip Code:74722-0180
Mailing Address - Country:US
Mailing Address - Phone:580-241-5294
Mailing Address - Fax:580-241-5739
Practice Address - Street 1:6026 BATTIEST PICKENS RD
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-5033
Practice Address - Country:US
Practice Address - Phone:580-241-5294
Practice Address - Fax:580-241-5739
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183131223G0001X
OK59931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice