Provider Demographics
NPI:1710141270
Name:EBY, MARK ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:EBY
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 1:15555 S TELEGRAPH RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-4000
Mailing Address - Country:US
Mailing Address - Phone:734-243-5200
Mailing Address - Fax:734-241-6127
Practice Address - Street 1:15555 S TELEGRAPH RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-4000
Practice Address - Country:US
Practice Address - Phone:734-243-5200
Practice Address - Fax:734-241-6127
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010181991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice