Provider Demographics
NPI:1770635781
Name:TREBON, MARK ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:TREBON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25251 PASEO DE ALICIA
Mailing Address - Street 2:STE 202
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-770-7077
Mailing Address - Fax:949-770-8336
Practice Address - Street 1:25251 PASEO DE ALICIA
Practice Address - Street 2:STE 202
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-770-7077
Practice Address - Fax:949-770-8336
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist