Provider Demographics
NPI:1780839803
Name:MARK L SHEFRIN DMD PC
Entity Type:Organization
Organization Name:MARK L SHEFRIN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEFRIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-497-8010
Mailing Address - Street 1:3540 DULUTH PARK LN STE 270
Mailing Address - Street 2:270
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8511
Mailing Address - Country:US
Mailing Address - Phone:770-497-8010
Mailing Address - Fax:
Practice Address - Street 1:3540 DULUTH PARK LN STE 270
Practice Address - Street 2:270
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8511
Practice Address - Country:US
Practice Address - Phone:770-497-8010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013646261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental