Active NPI
Mark John Lies, DMD
- General Practice Dentistry
- Great Falls, MT
National Provider Identifier
1700989381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1755
- Practice address
- 300 Park Dr S
Ste 203
Great Falls, MT 59405 - Phone
- (406) 453-6459
- Fax
- (406) 453-6466
- NPI assigned
- Sep 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1755 | MT | Primary |
Addresses
Primary practice location
300 Park Dr S
Ste 203
Great Falls, MT 59405
Mailing address
300 Park Dr S
Ste 203
Great Falls, MT 59405
Phone (406) 453-6459
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 048217 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1755 | MT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700989381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 PARK DR S",
"address_2": "STE 203",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "59405",
"telephone_number": "406-453-6459",
"fax_number": "406-453-6466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 PARK DR S",
"address_2": "STE 203",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "59405",
"telephone_number": "406-453-6459",
"fax_number": "406-453-6466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIES",
"first_name": "MARK",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MT",
"license": "1755",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "048217",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Great Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.