Provider Demographics
NPI:1699806158
Name:KEARNS, MARK J (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:KEARNS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-1117
Mailing Address - Country:US
Mailing Address - Phone:717-774-1200
Mailing Address - Fax:717-774-2568
Practice Address - Street 1:1412 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17070-1117
Practice Address - Country:US
Practice Address - Phone:717-774-1200
Practice Address - Fax:717-774-2568
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028294L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMI279056OtherUNITED CONCORDIA PROV. #