Provider Demographics
NPI:1528270634
Name:BOTTORFF, MARK WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM
Last Name:BOTTORFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9302 N COLTON STREET
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1290
Mailing Address - Country:US
Mailing Address - Phone:509-863-9460
Mailing Address - Fax:509-868-0428
Practice Address - Street 1:9302 N COLTON STREET
Practice Address - Street 2:SUITE #100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1290
Practice Address - Country:US
Practice Address - Phone:509-863-9460
Practice Address - Fax:509-868-0428
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WADE000097931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice