Provider Demographics
NPI:1316555048
Name:MARK ANTONIS DDS, LLC
Entity Type:Organization
Organization Name:MARK ANTONIS DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:ANTONIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-866-5391
Mailing Address - Street 1:1333 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-2624
Mailing Address - Country:US
Mailing Address - Phone:610-866-5391
Mailing Address - Fax:610-866-5421
Practice Address - Street 1:1333 EASTON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-2624
Practice Address - Country:US
Practice Address - Phone:610-866-5391
Practice Address - Fax:610-866-5421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental