Provider Demographics
NPI:1710117130
Name:RANGEL, MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:RANGEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 ANTILLEY RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5265
Mailing Address - Country:US
Mailing Address - Phone:325-692-6300
Mailing Address - Fax:325-692-6301
Practice Address - Street 1:1665 ANTILLEY RD
Practice Address - Street 2:STE. 300
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5265
Practice Address - Country:US
Practice Address - Phone:325-692-6300
Practice Address - Fax:325-692-6301
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00248371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice