Provider Demographics
NPI:1851451470
Name:MARK FRANKLIN SILLS DDS PC
Entity Type:Organization
Organization Name:MARK FRANKLIN SILLS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS PC
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-279-2022
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:602 HOOSIER AVE
Mailing Address - City:OOLITIC
Mailing Address - State:IN
Mailing Address - Zip Code:47451
Mailing Address - Country:US
Mailing Address - Phone:812-279-2022
Mailing Address - Fax:812-277-9915
Practice Address - Street 1:602 HOOSIER AVE
Practice Address - Street 2:
Practice Address - City:OOLITIC
Practice Address - State:IN
Practice Address - Zip Code:47451
Practice Address - Country:US
Practice Address - Phone:812-279-2022
Practice Address - Fax:812-277-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120097811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200180760AMedicaid