Provider Demographics
NPI:1457408114
Name:TORNATORE, MARK BRYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BRYAN
Last Name:TORNATORE
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 1:6536 ANTHONY DRIVE
Mailing Address - Street 2:EAST VICTOR PLACE SUITE A
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9395
Mailing Address - Country:US
Mailing Address - Phone:585-924-8940
Mailing Address - Fax:585-924-5817
Practice Address - Street 1:6536 ANTHONY DRIVE SUITE A
Practice Address - Street 2:EAST VICTOR PLACE
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564
Practice Address - Country:US
Practice Address - Phone:585-924-8940
Practice Address - Fax:585-924-5817
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0403271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice