Provider Demographics
NPI:1396860524
Name:MARK GIORNO DMD & ASSOCIATE PA
Entity Type:Organization
Organization Name:MARK GIORNO DMD & ASSOCIATE PA
Other - Org Name:MAIN STREET DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIORNO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-678-4400
Mailing Address - Street 1:333 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1247
Mailing Address - Country:US
Mailing Address - Phone:856-678-4400
Mailing Address - Fax:856-678-4808
Practice Address - Street 1:333 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1247
Practice Address - Country:US
Practice Address - Phone:856-678-4400
Practice Address - Fax:856-678-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD10180811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty