Provider Demographics
NPI:1679551790
Name:MARK SHURETT DDS PC
Entity type:Organization
Organization Name:MARK SHURETT DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-760-7900
Mailing Address - Street 1:1806 OVER LAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1745
Mailing Address - Country:US
Mailing Address - Phone:770-760-7900
Mailing Address - Fax:770-760-1375
Practice Address - Street 1:1806 OVER LAKE DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1745
Practice Address - Country:US
Practice Address - Phone:770-760-7900
Practice Address - Fax:770-760-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental