Provider Demographics
NPI:1831301852
Name:PAKAN, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PAKAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5918 BERGENLINE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1392
Mailing Address - Country:US
Mailing Address - Phone:201-861-6555
Mailing Address - Fax:973-817-8888
Practice Address - Street 1:5918 BERGENLINE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1392
Practice Address - Country:US
Practice Address - Phone:201-861-6555
Practice Address - Fax:973-817-8888
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021820001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics