Provider Demographics
NPI:1912062902
Name:OSENIEKS, MARK ALLAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLAN
Last Name:OSENIEKS
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 1:11225 TALLMADGE WOODS DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-6306
Mailing Address - Country:US
Mailing Address - Phone:616-453-0002
Mailing Address - Fax:
Practice Address - Street 1:O-11225 TALLMADGE WOODS DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-6313
Practice Address - Country:US
Practice Address - Phone:616-453-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016297122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist