Provider Demographics
NPI:1124012141
Name:PCOLINSKY, MARK PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PAUL
Last Name:PCOLINSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6807 KNIGHTDALE BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6562
Mailing Address - Country:US
Mailing Address - Phone:919-217-4411
Mailing Address - Fax:919-217-4420
Practice Address - Street 1:6807 KNIGHTDALE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6562
Practice Address - Country:US
Practice Address - Phone:919-217-4411
Practice Address - Fax:919-217-4420
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO2248700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist