Provider Demographics
NPI:1639248917
Name:POCRNICH, MARK A (DDS)
Entity type:Individual
Prefix:PROF
First Name:MARK
Middle Name:A
Last Name:POCRNICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 ASHLAND ST S
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1518
Mailing Address - Country:US
Mailing Address - Phone:763-689-1151
Mailing Address - Fax:763-689-2009
Practice Address - Street 1:223 ASHLAND ST S
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1518
Practice Address - Country:US
Practice Address - Phone:763-689-1151
Practice Address - Fax:763-689-2009
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN81531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT66014Medicare UPIN