Provider Demographics
NPI:1164546453
Name:GEARY, MARK J (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:GEARY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1562 CONSTITUTION BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3004
Mailing Address - Country:US
Mailing Address - Phone:803-324-7686
Mailing Address - Fax:803-324-5344
Practice Address - Street 1:1562 CONSTITUTION BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3004
Practice Address - Country:US
Practice Address - Phone:803-324-7686
Practice Address - Fax:803-324-5344
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC40601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice