Provider Demographics
NPI:1811916539
Name:VOLTAREL, MARK LOUIS (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LOUIS
Last Name:VOLTAREL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 HARLEY STRICKLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7947
Mailing Address - Country:US
Mailing Address - Phone:386-774-4777
Mailing Address - Fax:386-774-1996
Practice Address - Street 1:751 HARLEY STRICKLAND BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7947
Practice Address - Country:US
Practice Address - Phone:386-774-4777
Practice Address - Fax:386-774-1996
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 128081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice