Provider Demographics
NPI:1720283856
Name:DENNIS, MARK ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:DENNIS
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 1:16104 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350
Mailing Address - Country:US
Mailing Address - Phone:248-328-8888
Mailing Address - Fax:248-634-0440
Practice Address - Street 1:16104 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:DAVISBURG
Practice Address - State:MI
Practice Address - Zip Code:48350
Practice Address - Country:US
Practice Address - Phone:248-328-8888
Practice Address - Fax:248-634-0440
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010165821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice