Provider Demographics
NPI:1306917406
Name:MARK MAMARI DDS. PSC. INC.
Entity type:Organization
Organization Name:MARK MAMARI DDS. PSC. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:859-426-9666
Mailing Address - Street 1:2503 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1701
Mailing Address - Country:US
Mailing Address - Phone:859-426-9666
Mailing Address - Fax:
Practice Address - Street 1:2503 CHELSEA DR
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-1701
Practice Address - Country:US
Practice Address - Phone:859-426-9666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7221261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental