Provider Demographics
NPI:1245360304
Name:SWERDLOFF, MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SWERDLOFF
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNY AT STONY BROOK SCHOOL OF DENTAL MEDICINE DEPT OF
Mailing Address - Street 2:ORAL & MAXILLOFACIAL SURGERY HSC S CAMPUS WESTCHESTER
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8704
Mailing Address - Country:US
Mailing Address - Phone:631-632-8952
Mailing Address - Fax:631-632-7658
Practice Address - Street 1:SUNY AT STONY BROOK SCHOOL OF DENTAL MEDICINE
Practice Address - Street 2:SULLIVAN HALL ROOM 170
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-632-8971
Practice Address - Fax:631-632-7658
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDDS295901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00680231Medicaid
NYD18152Medicare ID - Type Unspecified
NY00680231Medicaid