Provider Demographics
NPI:1720410376
Name:MUSICARO, MARK
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:MUSICARO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 REILLY ST
Mailing Address - Street 2:MCDS NA B
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-8757
Mailing Address - Country:US
Mailing Address - Phone:910-643-2196
Mailing Address - Fax:910-396-7017
Practice Address - Street 1:2617 REILLY ST
Practice Address - Street 2:MCDS NA B
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-8757
Practice Address - Country:US
Practice Address - Phone:910-643-2196
Practice Address - Fax:910-396-7017
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6346122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist