Provider Demographics
NPI:1538246301
Name:DUKE, MARK E (DMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:DUKE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1477
Mailing Address - Street 2:
Mailing Address - City:PRIEST RIVER
Mailing Address - State:ID
Mailing Address - Zip Code:83856
Mailing Address - Country:US
Mailing Address - Phone:208-448-1241
Mailing Address - Fax:208-448-1242
Practice Address - Street 1:103 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRIEST RIVER
Practice Address - State:ID
Practice Address - Zip Code:83856-5059
Practice Address - Country:US
Practice Address - Phone:208-442-1241
Practice Address - Fax:208-448-1242
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3968122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist