Provider Demographics
NPI:1700054533
Name:MARK W. DAVEY, DDS, PC
Entity Type:Organization
Organization Name:MARK W. DAVEY, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-348-2626
Mailing Address - Street 1:5653 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-6737
Mailing Address - Country:US
Mailing Address - Phone:989-348-2626
Mailing Address - Fax:989-348-2996
Practice Address - Street 1:5653 WALKER DR
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-6737
Practice Address - Country:US
Practice Address - Phone:989-348-2626
Practice Address - Fax:989-348-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI013133261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental