Provider Demographics
NPI:1437162344
Name:PRYBYL, JOSEPH MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARK
Last Name:PRYBYL
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 1:697 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-4031
Mailing Address - Country:US
Mailing Address - Phone:247-766-2609
Mailing Address - Fax:
Practice Address - Street 1:697 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-4031
Practice Address - Country:US
Practice Address - Phone:724-766-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022948L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030908820008Medicaid
PA1030908820002Medicaid
PA1030908820009Medicaid
PA1030908820006Medicaid
PA1030908820004Medicaid
PA1030908820005Medicaid
PA1030908820007Medicaid