Jeffrey Mark, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2016019198 Issued in MO

Practice address

4801 S Cliff Ave Ste 208
Independence, MO 64055-6954

Phone

(816) 461-3660

Fax

(816) 461-4151

NPI assigned

Oct 25, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mark Dental, LLC

  • General Practice Dentistry
  • Independence, MO
  • NPI 1588559033
  NPD
• Kaw Valley Family Dental LLC

  • Dentist
  • Edwardsville, KS
  • NPI 1114592938
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566259200000",
    "number": "1689126724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 NE OVERLAND DR",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640298604",
            "telephone_number": "816-875-9154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 S CLIFF AVE STE 208",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640556954",
            "telephone_number": "816-461-3660",
            "fax_number": "816-461-4151"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10601 Kaw Dr",
            "address_purpose": "LOCATION",
            "city": "Edwardsville",
            "state": "KS",
            "postal_code": "661111130",
            "country_code": "US",
            "telephone_number": "913-441-3373",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2225 NE Overland Dr",
            "address_purpose": "LOCATION",
            "city": "Blue Springs",
            "state": "MO",
            "postal_code": "640298604",
            "country_code": "US",
            "telephone_number": "816-875-9154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARK",
        "first_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-25",
        "last_updated": "2019-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NV",
            "license": "6845",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "61488",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2016019198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shahzaib I Maqbool, MBBS
• Marian Hope (Marian Hope Academy)
• Mark Dental, LLC
• Mark R. Killman, M.D. P.C.
• Mark Smith, Professional Services, LLC
• Richard George Mark, DDS
• Sophia Markowsky
• Gregory Alan Markway, MD
• Anna Marie Marren, MD
• Ally M Marshall, MSW, LCSW

• General Practice Dentistry in Independence, MO
• Providers in Independence, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.