Provider Demographics
NPI:1861507329
Name:MARK F SOUERS DDS PA
Entity Type:Organization
Organization Name:MARK F SOUERS DDS PA
Other - Org Name:MARK F SOUERS DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:FOSTER
Authorized Official - Last Name:SOUERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-476-6655
Mailing Address - Street 1:1421 WAYZATA BLVD
Mailing Address - Street 2:SUITE #325
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1939
Mailing Address - Country:US
Mailing Address - Phone:952-476-6655
Mailing Address - Fax:952-476-8293
Practice Address - Street 1:1421 WAYZATA BLVD
Practice Address - Street 2:SUITE #325
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1939
Practice Address - Country:US
Practice Address - Phone:952-476-6655
Practice Address - Fax:952-476-8293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND103301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty