Provider Demographics
NPI:1710058383
Name:TOMUIK, MARK G (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:TOMUIK
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 1:1850 HALESWORTH LN
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9000
Mailing Address - Country:US
Mailing Address - Phone:585-265-2849
Mailing Address - Fax:
Practice Address - Street 1:1510 RIDGE RD W
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-2405
Practice Address - Country:US
Practice Address - Phone:585-865-6691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04975411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice