Provider Demographics
NPI:1174736482
Name:BRITTEN, MARK DEMING (DMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DEMING
Last Name:BRITTEN
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 1:23 WATER ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-5119
Mailing Address - Country:US
Mailing Address - Phone:207-282-6139
Mailing Address - Fax:207-282-6130
Practice Address - Street 1:23 WATER ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-5119
Practice Address - Country:US
Practice Address - Phone:207-282-6139
Practice Address - Fax:207-282-6130
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME31681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM0884Medicare ID - Type Unspecified