Individual
DR. MARK M ORTINAU
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
12 HUTCHINSON RD, ELLISVILLE, MO 63011-5702
(636) 391-0122
(636) 391-0185
Mailing address
12 HUTCHINSON RD, ELLISVILLE, MO 63011-5702
(636) 391-0122
(636) 391-0185
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12093
MO
Other
Enumeration date
06/06/2006
Last updated
07/08/2007
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