Provider Demographics
NPI:1326655317
Name:MARK EDWARD DEMARIA DMD MS PLLC
Entity Type:Organization
Organization Name:MARK EDWARD DEMARIA DMD MS PLLC
Other - Org Name:ABRAHAM AND GILL
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DEMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:724-537-5570
Mailing Address - Street 1:373 FRYE FARM RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6479
Mailing Address - Country:US
Mailing Address - Phone:724-537-5570
Mailing Address - Fax:
Practice Address - Street 1:373 FRYE FARM RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6479
Practice Address - Country:US
Practice Address - Phone:724-537-5570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK EDWARD DEMARIA DMD MS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-24
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental