Provider Demographics
NPI:1285652404
Name:MARK, ROLAND TONG (DDS)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:TONG
Last Name:MARK
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 1:147 LONG LN
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-3116
Mailing Address - Country:US
Mailing Address - Phone:610-352-2333
Mailing Address - Fax:610-352-2333
Practice Address - Street 1:147 LONG LN
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-3116
Practice Address - Country:US
Practice Address - Phone:610-352-2333
Practice Address - Fax:610-352-2333
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-022259-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice