Provider Demographics
NPI:1811107774
Name:BEDARD, MARK ONESIEME (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ONESIEME
Last Name:BEDARD
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 1:11922 SEACREST DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-1937
Mailing Address - Country:US
Mailing Address - Phone:714-530-7411
Mailing Address - Fax:714-530-7569
Practice Address - Street 1:11922 SEACREST DR
Practice Address - Street 2:SUITE F
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-1937
Practice Address - Country:US
Practice Address - Phone:714-530-7411
Practice Address - Fax:714-530-7569
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA322691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice