Provider Demographics
NPI:1972642718
Name:BILLS, MARK MCEWEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MCEWEN
Last Name:BILLS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 NASSAU ST SO
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2308
Mailing Address - Country:US
Mailing Address - Phone:941-488-2000
Mailing Address - Fax:841-485-0280
Practice Address - Street 1:189 NASSAU ST SO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2308
Practice Address - Country:US
Practice Address - Phone:941-488-2000
Practice Address - Fax:841-485-0280
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist