Provider Demographics
NPI:1982841763
Name:MARK GIORNO DMD AND ASSCO. PA.
Entity Type:Organization
Organization Name:MARK GIORNO DMD AND ASSCO. PA.
Other - Org Name:MAIN STREET DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GIORNO
Authorized Official - Last Name:GIORNO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-241-8600
Mailing Address - Street 1:1 WHEATLEY BLVD
Mailing Address - Street 2:BUILDING K
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062
Mailing Address - Country:US
Mailing Address - Phone:856-223-0041
Mailing Address - Fax:856-223-0020
Practice Address - Street 1:1 WHEATLEY BLVD
Practice Address - Street 2:BUILDING K
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062
Practice Address - Country:US
Practice Address - Phone:856-223-0041
Practice Address - Fax:856-223-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0180811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty