DR. Mark Lance Ethridge, D.D.S.

NPI #1164513685 in Richardson, Texas

Provider Information

NPI Number: 1164513685
Entity Type: Individual
Name: DR. Mark Lance Ethridge, D.D.S.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist
Credential: D.D.S.
Enumeration Date: Sep 28, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 1101 N JUPITER RD
Address 2: SUITE 109
City: Richardson
State: Texas
ZIP Code: 75081-3171
Phone: (972) 669-9060

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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