Provider Demographics
NPI:1598784837
Name:ZAHN, MARK DAVID (DDS,MS, PC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:ZAHN
Suffix:
Gender:M
Credentials:DDS,MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3919
Mailing Address - Country:US
Mailing Address - Phone:734-994-9145
Mailing Address - Fax:734-994-5162
Practice Address - Street 1:2207 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3919
Practice Address - Country:US
Practice Address - Phone:734-994-9145
Practice Address - Fax:734-994-5162
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010148831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-3545526OtherEIN