Provider Demographics
NPI:1083680102
Name:STRAKA, MARK A (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:STRAKA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3996
Mailing Address - Country:US
Mailing Address - Phone:614-267-0385
Mailing Address - Fax:614-267-1407
Practice Address - Street 1:3545 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 125
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3996
Practice Address - Country:US
Practice Address - Phone:614-267-0385
Practice Address - Fax:614-267-1407
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300158351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0391179Medicaid
OH0391179Medicaid