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Individual
MARK E. PICKETT
Active
Individual
MARK E. PICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
2558
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58716
BCBS
AR
01
—
884614
UNITED CONCORDIA
AR
Enumeration date
10/12/2006
Last updated
07/08/2007
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