Provider Demographics
NPI:1306907274
Name:HALEK, MARK F (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:HALEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 EXECUTIVE PARK CT
Mailing Address - Street 2:STE 1600
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6045
Mailing Address - Country:US
Mailing Address - Phone:407-774-4433
Mailing Address - Fax:407-774-8475
Practice Address - Street 1:660 EXECUTIVE PARK CT
Practice Address - Street 2:STE 1600
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6045
Practice Address - Country:US
Practice Address - Phone:407-774-4433
Practice Address - Fax:407-774-8475
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593259599OtherFEDERAL TAX ID