Mark Wiatt, DDS

NPI #1801889209 in T Or C, New Mexico

Provider Information

NPI Number: 1801889209
Entity Type: Individual
Name: Mark Wiatt, DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: Aug 31, 2005
Last Updated: Dec 18, 2007

Practice Location

Address: 1960 N DATE ST
City: T Or C
State: New Mexico
ZIP Code: 87901-3701
Phone: (505) 267-3088

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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