Provider Demographics
NPI:1366977282
Name:MRC DENTAL GROUP
Entity type:Organization
Organization Name:MRC DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHAPKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-249-9292
Mailing Address - Street 1:425 S AVALON PARK BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6703
Mailing Address - Country:US
Mailing Address - Phone:407-249-9292
Mailing Address - Fax:
Practice Address - Street 1:425 S AVALON PARK BLVD STE 500
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6703
Practice Address - Country:US
Practice Address - Phone:407-249-9292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty