Wiatt, Mark
Wiatt, Mark is an individual health care provider with primary practice located at 1960 N Date St , T Or C NM 87901-3701. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Wiatt, Mark can be contacted via phone (505) 267-3088.Contact Information
Primary practice address
1960 N Date St
T Or C NM 87901-3701
Phone: (505) 267-3088
Fax: (505) 267-1747
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | DD-2602 | New Mexico |
Profile Details
| NPI number | 1801889209 |
|---|---|
| LBN Legal business name | Wiatt, Mark |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 31st, 2005 |
| Last updated | Dec 18th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1801889209 | NPPES |
| New Mexico | MEDICAID | 92422071 |
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