Provider Demographics
NPI:1194934430
Name:PASSELL, MARK S (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:PASSELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7201 N 19TH AVE
Mailing Address - Street 2:STE #1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7975
Mailing Address - Country:US
Mailing Address - Phone:602-995-5045
Mailing Address - Fax:602-995-3222
Practice Address - Street 1:7201 N 19TH AVE
Practice Address - Street 2:STE #1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7975
Practice Address - Country:US
Practice Address - Phone:602-995-5045
Practice Address - Fax:602-995-3222
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17541223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics