Provider Demographics
NPI:1871883033
Name:MACEK, MARK DAVID (DDS, DRPH)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:MACEK
Suffix:
Gender:M
Credentials:DDS, DRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W BALTIMORE ST
Mailing Address - Street 2:2207
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1510
Mailing Address - Country:US
Mailing Address - Phone:410-706-4218
Mailing Address - Fax:410-706-4031
Practice Address - Street 1:650 W BALTIMORE ST
Practice Address - Street 2:2207
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-706-4218
Practice Address - Fax:410-706-4031
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15551122300000X
IL019022453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist