Provider Demographics
NPI:1265614861
Name:GROSKO, MARK L (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:GROSKO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:843 N 21ST ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-7273
Mailing Address - Country:US
Mailing Address - Phone:740-344-6349
Mailing Address - Fax:740-344-6350
Practice Address - Street 1:843 N 21ST ST
Practice Address - Street 2:SUITE 103
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-7273
Practice Address - Country:US
Practice Address - Phone:740-344-6349
Practice Address - Fax:740-344-6350
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH215551223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH440265OtherSUPERIOR DENTAL
OH2424693Medicaid
OH256022OtherCIGNA
OH9185647OtherDORAL
OH1400162OtherUNITED CONCORDIA
OH187028OtherCOMP BENEFITS
OH25 1901759027OtherCARESOURCE