Provider Demographics
NPI:1821167370
Name:WHITFIELD, MARK TODD (DDS,PA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:TODD
Last Name:WHITFIELD
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 W ELDORADO PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4398
Mailing Address - Country:US
Mailing Address - Phone:972-542-8006
Mailing Address - Fax:972-547-4415
Practice Address - Street 1:2530 W ELDORADO PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4398
Practice Address - Country:US
Practice Address - Phone:972-542-8006
Practice Address - Fax:972-547-4415
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice