Provider Demographics
NPI:1336263961
Name:SOCCIO, MARK A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:SOCCIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 PELLIS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4583
Mailing Address - Country:US
Mailing Address - Phone:724-837-8030
Mailing Address - Fax:724-837-8031
Practice Address - Street 1:510 PELLIS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4583
Practice Address - Country:US
Practice Address - Phone:724-837-8030
Practice Address - Fax:724-837-8031
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025987-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice