Provider Demographics
NPI:1295852499
Name:DLUGOKINSKI, MARK DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:DLUGOKINSKI
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 1:101 RIVERSTONE VISTA
Mailing Address - Street 2:STE 202
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513
Mailing Address - Country:US
Mailing Address - Phone:706-258-4166
Mailing Address - Fax:706-258-4167
Practice Address - Street 1:101 RIVERSTONE VISTA
Practice Address - Street 2:STE 202
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513
Practice Address - Country:US
Practice Address - Phone:706-258-4166
Practice Address - Fax:706-258-4167
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0119431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice