Provider Demographics
NPI:1538358189
Name:MARK D. POGUE, M.D. D.D.S., P.C.
Entity type:Organization
Organization Name:MARK D. POGUE, M.D. D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:POGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-515-5400
Mailing Address - Street 1:8535 E HARTFORD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5443
Mailing Address - Country:US
Mailing Address - Phone:480-515-5400
Mailing Address - Fax:480-515-5493
Practice Address - Street 1:8535 E HARTFORD DR STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5443
Practice Address - Country:US
Practice Address - Phone:480-515-5400
Practice Address - Fax:480-515-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26467204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ61133Medicare PIN
AZU79221Medicare UPIN