Provider Demographics
NPI:1154576346
Name:MARK R. MAHER DDS, INC.
Entity type:Organization
Organization Name:MARK R. MAHER DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-935-1159
Mailing Address - Street 1:1855 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5279
Mailing Address - Country:US
Mailing Address - Phone:925-935-1159
Mailing Address - Fax:925-935-1146
Practice Address - Street 1:1855 SAN MIGUEL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5279
Practice Address - Country:US
Practice Address - Phone:925-935-1159
Practice Address - Fax:925-935-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52887261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental