Provider Demographics
NPI:1679531826
Name:REDFORD, MARK W (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:REDFORD
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 1:79 SCRIPPS DR STE 204
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6208
Mailing Address - Country:US
Mailing Address - Phone:916-565-2570
Mailing Address - Fax:916-569-8467
Practice Address - Street 1:79 SCRIPPS DR STE 204
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6208
Practice Address - Country:US
Practice Address - Phone:916-565-2570
Practice Address - Fax:916-569-8467
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-38461223G0001X
CA603711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice