Individual
MRS. MARY MARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1313 FAIRGROUNDS ROAD, PO BOX 146, TWO HARBORS, MN 55616-3000
(218) 206-4327
Mailing address
1313 FAIRGROUNDS RD, TWO HARBORS, MN 55616-4600
(218) 206-4327
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
04720
MN
124Q00000X
Dental Hygienist
5398016
WI
Other
Enumeration date
11/13/2011
Last updated
03/17/2018
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