Provider Demographics
NPI:1861406076
Name:PFEIFFER, MARK ANDREW (DMD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW
Last Name:PFEIFFER
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 1:20 N GRAND AVE
Mailing Address - Street 2:SUITE #10
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-4106
Mailing Address - Country:US
Mailing Address - Phone:859-441-1900
Mailing Address - Fax:
Practice Address - Street 1:20 N GRAND AVE
Practice Address - Street 2:SUITE #10
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4106
Practice Address - Country:US
Practice Address - Phone:859-441-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice