Provider Demographics
NPI:1629457197
Name:PUGLIESE, MARK C (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:PUGLIESE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 HAY TER
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-4651
Mailing Address - Country:US
Mailing Address - Phone:610-252-3861
Mailing Address - Fax:610-253-7934
Practice Address - Street 1:2031 HAY TERRACE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:610-252-3861
Practice Address - Fax:610-253-7934
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN0021881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice