Provider Demographics
NPI:1992833917
Name:PRICE, MARK A (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:PRICE
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3250
Mailing Address - Country:US
Mailing Address - Phone:802-773-3130
Mailing Address - Fax:802-775-7013
Practice Address - Street 1:58 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3250
Practice Address - Country:US
Practice Address - Phone:802-773-3130
Practice Address - Fax:802-775-7013
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT20051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics