Provider Demographics
NPI:1154605673
Name:RUARK, MARK JAMES II (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:RUARK
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2441 OLD FORT PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-4162
Mailing Address - Country:US
Mailing Address - Phone:615-848-9091
Mailing Address - Fax:615-848-9092
Practice Address - Street 1:2441 OLD FORT PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-4162
Practice Address - Country:US
Practice Address - Phone:615-848-9091
Practice Address - Fax:615-848-9092
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9569122300000X
LA62291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice