Individual
DR. MARK B. TICKLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
711 KORNEGAY DR, SUITE A, PRATTVILLE, AL 36066-7715
(334) 285-7111
(334) 285-3310
Mailing address
711 KORNEGAY DR, SUITE A, PRATTVILLE, AL 36066-7715
(334) 285-7111
(334) 285-3310
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5706
AL
Other
Enumeration date
09/15/2009
Last updated
09/15/2009
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