Provider Demographics
NPI:1023145851
Name:NEFF, MARK E (DES)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:NEFF
Suffix:
Gender:M
Credentials:DES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1303
Mailing Address - Country:US
Mailing Address - Phone:740-653-8100
Mailing Address - Fax:740-653-8105
Practice Address - Street 1:1532 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1303
Practice Address - Country:US
Practice Address - Phone:740-653-8100
Practice Address - Fax:740-653-8105
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH199671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0968298Medicaid