Provider Demographics
NPI:1396964003
Name:MARK J. MOKAS D.D.S., P.C.
Entity type:Organization
Organization Name:MARK J. MOKAS D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-671-1111
Mailing Address - Street 1:7260 ROSWELL RD NE
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1420
Mailing Address - Country:US
Mailing Address - Phone:770-671-1111
Mailing Address - Fax:770-379-0992
Practice Address - Street 1:7260 ROSWELL RD NE
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-1420
Practice Address - Country:US
Practice Address - Phone:770-671-1111
Practice Address - Fax:770-379-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty