Provider Demographics
NPI:1629161518
Name:KAHN, MARK A (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:KAHN
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6211 W 30TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-3048
Mailing Address - Country:US
Mailing Address - Phone:317-299-0353
Mailing Address - Fax:317-298-8196
Practice Address - Street 1:6211 W 30TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3048
Practice Address - Country:US
Practice Address - Phone:317-299-0353
Practice Address - Fax:317-298-8196
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120090761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry