Provider Demographics
NPI:1700574068
Name:MARK C. MCDADE DMD
Entity type:Organization
Organization Name:MARK C. MCDADE DMD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCDADE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:805-482-7615
Mailing Address - Street 1:771 E DAILY DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-0782
Mailing Address - Country:US
Mailing Address - Phone:805-482-7615
Mailing Address - Fax:
Practice Address - Street 1:771 E DAILY DR STE 130
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-0782
Practice Address - Country:US
Practice Address - Phone:805-482-7615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty