Provider Demographics
NPI:1952700130
Name:MAHAFFEY, MARK J (DDS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:J
Last Name:MAHAFFEY
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 1:3695 FM 3514
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-7653
Mailing Address - Country:US
Mailing Address - Phone:409-724-1515
Mailing Address - Fax:
Practice Address - Street 1:3695 FM 3514
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-7653
Practice Address - Country:US
Practice Address - Phone:409-724-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist