Provider Demographics
NPI:1699986083
Name:DAVEY, MARK WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:DAVEY
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 1:5653 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-6737
Mailing Address - Country:US
Mailing Address - Phone:989-348-2626
Mailing Address - Fax:989-348-2996
Practice Address - Street 1:5653 WALKER DR
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-6737
Practice Address - Country:US
Practice Address - Phone:989-348-2626
Practice Address - Fax:989-348-2996
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI013133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist