Provider Demographics
NPI:1255370060
Name:VENINCASA, MARK ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:VENINCASA
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 1:17330 PRESTON RD
Mailing Address - Street 2:SUITE 116-D
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5728
Mailing Address - Country:US
Mailing Address - Phone:972-250-2580
Mailing Address - Fax:972-250-0134
Practice Address - Street 1:17330 PRESTON RD
Practice Address - Street 2:SUITE 116-D
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5728
Practice Address - Country:US
Practice Address - Phone:972-250-2580
Practice Address - Fax:972-250-0134
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice