Individual
DR. MARK RICHARD CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
4431 68TH STREET, U S ARMY DENTAL ACTIVITY, FORT HOOD, TX 76544
(253) 495-1193
Mailing address
1011 SURREY TRCE SE, TUMWATER, WA 98501-8624
(253) 495-1193
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8618
KY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
60884792
WA
Other
Enumeration date
06/12/2008
Last updated
12/04/2019
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