Provider Demographics
NPI:1245495860
Name:ENCE, MARK RAYNEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:RAYNEL
Last Name:ENCE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:754 S MAIN ST
Mailing Address - Street 2:STE. #1
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5504
Mailing Address - Country:US
Mailing Address - Phone:435-628-2667
Mailing Address - Fax:435-628-6205
Practice Address - Street 1:754 S MAIN ST
Practice Address - Street 2:STE. #1
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5504
Practice Address - Country:US
Practice Address - Phone:435-628-2667
Practice Address - Fax:435-628-6205
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT7050655-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice