Provider Demographics
NPI:1013018027
Name:CHESLIK, MARK (DPD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:CHESLIK
Suffix:
Gender:M
Credentials:DPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 15TH PL NE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98205-1485
Mailing Address - Country:US
Mailing Address - Phone:425-377-1664
Mailing Address - Fax:
Practice Address - Street 1:4367 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2213
Practice Address - Country:US
Practice Address - Phone:425-259-2800
Practice Address - Fax:425-259-2800
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN 00000342122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5043450OtherDSHS PROVIDER NUMBER