Provider Demographics
NPI:1093916876
Name:MARK C LOSCHIAVO DMD PA
Entity Type:Organization
Organization Name:MARK C LOSCHIAVO DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOSCHIAVO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-342-6454
Mailing Address - Street 1:920 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5017
Mailing Address - Country:US
Mailing Address - Phone:201-342-6454
Mailing Address - Fax:
Practice Address - Street 1:920 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5017
Practice Address - Country:US
Practice Address - Phone:201-342-6454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01796400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty