Provider Demographics
NPI:1568582112
Name:MARK H. DOCKTOR DDS PA
Entity Type:Organization
Organization Name:MARK H. DOCKTOR DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:DOCKTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-963-9000
Mailing Address - Street 1:726 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5002
Mailing Address - Country:US
Mailing Address - Phone:201-963-9000
Mailing Address - Fax:201-795-9008
Practice Address - Street 1:726 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5002
Practice Address - Country:US
Practice Address - Phone:201-963-9000
Practice Address - Fax:201-795-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ96061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty