Provider Demographics
NPI:1760467609
Name:MARKT, JEFFERY CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:CRAIG
Last Name:MARKT
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 1:981225 NEBRASKA MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-1225
Mailing Address - Country:US
Mailing Address - Phone:402-559-7978
Mailing Address - Fax:402-559-8940
Practice Address - Street 1:981225 NEBRASKA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-1225
Practice Address - Country:US
Practice Address - Phone:402-559-7978
Practice Address - Fax:402-559-8940
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA400081223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0166165Medicaid
IA42196Medicare ID - Type Unspecified
IA0166165Medicaid