Provider Demographics
NPI:1750644092
Name:CUMMINGS, MARK SIMEON (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:SIMEON
Last Name:CUMMINGS
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 1:468 NC HWY 24-87
Mailing Address - Street 2:CAROLINA LAKES FAMILY DENTISTRY
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326
Mailing Address - Country:US
Mailing Address - Phone:919-498-0575
Mailing Address - Fax:
Practice Address - Street 1:468 NC HWY 24-87
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326
Practice Address - Country:US
Practice Address - Phone:919-498-0575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice