Provider Demographics
NPI:1760779987
Name:KAUFMAN, MARK D (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:KAUFMAN
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 1:500 E OLIVE AVE
Mailing Address - Street 2:SUITE #330
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-3316
Mailing Address - Country:US
Mailing Address - Phone:818-845-7700
Mailing Address - Fax:818-845-7834
Practice Address - Street 1:500 E OLIVE AVE
Practice Address - Street 2:SUITE #330
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-3316
Practice Address - Country:US
Practice Address - Phone:818-845-7700
Practice Address - Fax:818-845-7834
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31643OtherLICENSE