Provider Demographics
NPI:1982827762
Name:TING, MARK M
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:TING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 FRANKLIN ST STE 418
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2822
Mailing Address - Country:US
Mailing Address - Phone:510-444-1660
Mailing Address - Fax:510-444-6818
Practice Address - Street 1:1624 FRANKLIN ST STE 418
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2822
Practice Address - Country:US
Practice Address - Phone:510-444-1660
Practice Address - Fax:510-444-6818
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB27847-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice