Provider Demographics
NPI:1184733701
Name:FERRARI, MARK ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:FERRARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S WHITEHALL DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-5843
Mailing Address - Country:US
Mailing Address - Phone:847-991-4237
Mailing Address - Fax:847-991-9435
Practice Address - Street 1:1901 N ROSELLE RD
Practice Address - Street 2:SUITE 330
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3176
Practice Address - Country:US
Practice Address - Phone:847-884-6776
Practice Address - Fax:847-884-6888
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice