Individual
DR. MARK JONATHAN FOTOVAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
6671 SMOKE RANCH RD, LAS VEGAS, NV 89108-8419
(702) 869-8031
Mailing address
6671 SMOKE RANCH RD, LAS VEGAS, NV 89108-8419
(702) 869-8031
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6193
NV
Other
Enumeration date
06/24/2010
Last updated
11/04/2011
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