Provider Demographics
NPI:1730277104
Name:DREYER, MARK TODD (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:TODD
Last Name:DREYER
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 1:1380 GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-6611
Mailing Address - Country:US
Mailing Address - Phone:407-870-5041
Mailing Address - Fax:
Practice Address - Street 1:705 E OAK ST
Practice Address - Street 2:SUITE B
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4577
Practice Address - Country:US
Practice Address - Phone:407-933-0885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00110621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice