Provider Demographics
NPI:1295862845
Name:HUZYAK, MARK D (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:HUZYAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:741 FRONT ST
Mailing Address - Street 2:#330
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4991
Mailing Address - Country:US
Mailing Address - Phone:407-566-2222
Mailing Address - Fax:407-566-1650
Practice Address - Street 1:400 CELEBRATION PL
Practice Address - Street 2:A-260
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:407-566-2222
Practice Address - Fax:407-566-1650
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00105311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL63681BOtherPROVIDER ID BCBS FL
FL76OtherFEE ID WDW WRKER COMP
FL973990OtherGRP ID UNITED CONCORDIA
FL31240OtherGRP ID UNITED HEALTHCARE