Provider Demographics
NPI:1801312145
Name:HOUSTON, MARK (DMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HOUSTON
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 1:10800 SE 5TH ST UNIT E17
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-4633
Mailing Address - Country:US
Mailing Address - Phone:044-793-9509
Mailing Address - Fax:
Practice Address - Street 1:7275 SW DARTMOUTH ST STE 180
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8292
Practice Address - Country:US
Practice Address - Phone:503-620-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD121421223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty