Provider Demographics
NPI:1760452445
Name:TINDALL, MARK C (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:TINDALL
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 1:1133 COLLEGE AVE
Mailing Address - Street 2:BLDG. D, SUITE 200
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2770
Mailing Address - Country:US
Mailing Address - Phone:785-537-0136
Mailing Address - Fax:785-537-8591
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:BLDG. D, SUITE 200
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2770
Practice Address - Country:US
Practice Address - Phone:785-537-0136
Practice Address - Fax:785-537-8591
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS601281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS60128OtherDENTAL LICENSE NUMBER
KS60128OtherDENTAL LICENSE NUMBER
KS172849Medicare UPIN
KS1677464Medicare UPIN