Provider Demographics
NPI:1790863934
Name:DAVIES, MARK L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:DAVIES
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 1:1664 VILLAGE GRN
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2037
Mailing Address - Country:US
Mailing Address - Phone:301-261-3800
Mailing Address - Fax:301-261-3838
Practice Address - Street 1:1664 VILLAGE GRN
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2037
Practice Address - Country:US
Practice Address - Phone:301-261-3800
Practice Address - Fax:301-261-3838
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD85751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice