Provider Demographics
NPI:1518353846
Name:MARK A. ROLAND, DMD PC
Entity Type:Organization
Organization Name:MARK A. ROLAND, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-244-0944
Mailing Address - Street 1:101 E NORTHSIDE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1724
Mailing Address - Country:US
Mailing Address - Phone:229-244-0944
Mailing Address - Fax:229-244-0965
Practice Address - Street 1:101 E NORTHSIDE DR
Practice Address - Street 2:SUITE D
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1724
Practice Address - Country:US
Practice Address - Phone:229-244-0944
Practice Address - Fax:229-244-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty