Provider Demographics
NPI:1487887972
Name:SCHUTTE, MARK BRANDON (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:BRANDON
Last Name:SCHUTTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2527
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99302-2527
Mailing Address - Country:US
Mailing Address - Phone:509-989-3692
Mailing Address - Fax:
Practice Address - Street 1:6225 BURDEN BLVD
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:509-547-3000
Practice Address - Fax:509-547-3223
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60106594122300000X
WADE 601065941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist