Provider Demographics
NPI:1730246869
Name:VERMILLION, MARK ROGER (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ROGER
Last Name:VERMILLION
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3153
Mailing Address - Country:US
Mailing Address - Phone:937-275-2211
Mailing Address - Fax:937-275-4408
Practice Address - Street 1:5925 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3153
Practice Address - Country:US
Practice Address - Phone:937-275-2211
Practice Address - Fax:937-275-4408
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH185541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice