Provider Demographics
NPI:1215055819
Name:AXELRODE, MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:AXELRODE
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 1:2000 APPIAN WAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2574
Mailing Address - Country:US
Mailing Address - Phone:510-724-8855
Mailing Address - Fax:510-724-8861
Practice Address - Street 1:2000 APPIAN WAY
Practice Address - Street 2:SUITE 301
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2574
Practice Address - Country:US
Practice Address - Phone:510-724-8855
Practice Address - Fax:510-724-8861
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA405281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics