Provider Demographics
NPI:1205847621
Name:OFFENBACK, MARK STEVEN (DDS PA)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:OFFENBACK
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:686 HUNT CLUB BLVD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2218
Mailing Address - Country:US
Mailing Address - Phone:407-869-7333
Mailing Address - Fax:407-869-5720
Practice Address - Street 1:686 HUNT CLUB BLVD
Practice Address - Street 2:SUITE #100
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2218
Practice Address - Country:US
Practice Address - Phone:407-869-7333
Practice Address - Fax:407-869-5720
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN103591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice