Provider Demographics
NPI:1316265358
Name:DURHAM, MARK RICHARDS (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARDS
Last Name:DURHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4946 YORK ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1036
Mailing Address - Country:US
Mailing Address - Phone:504-324-4309
Mailing Address - Fax:
Practice Address - Street 1:4946 YORK ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1036
Practice Address - Country:US
Practice Address - Phone:504-324-4309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-15
Last Update Date:2010-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAS-4921223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics