Provider Demographics
NPI:1730264623
Name:TEPPER, MARK AUSTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:AUSTIN
Last Name:TEPPER
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 1:630 5TH AVE
Mailing Address - Street 2:SUITE 1863
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10111-0100
Mailing Address - Country:US
Mailing Address - Phone:212-969-9690
Mailing Address - Fax:212-489-3907
Practice Address - Street 1:630 5TH AVE
Practice Address - Street 2:SUITE 1863
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10111-0100
Practice Address - Country:US
Practice Address - Phone:212-969-9690
Practice Address - Fax:212-489-3907
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY354141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics