Provider Demographics
NPI:1366579823
Name:FUNKE, MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:FUNKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1898 COLLEGE PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7942
Mailing Address - Country:US
Mailing Address - Phone:775-882-5525
Mailing Address - Fax:775-882-5527
Practice Address - Street 1:1898 COLLEGE PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7942
Practice Address - Country:US
Practice Address - Phone:775-882-5525
Practice Address - Fax:775-882-5527
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV29381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice