Provider Demographics
NPI:1669566840
Name:DIRE, MARK L (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:DIRE
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 1:14259 209TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-5664
Mailing Address - Country:US
Mailing Address - Phone:425-883-7108
Mailing Address - Fax:
Practice Address - Street 1:12917 SE 38TH ST
Practice Address - Street 2:#202
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1349
Practice Address - Country:US
Practice Address - Phone:425-747-8052
Practice Address - Fax:425-562-7222
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA46101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice