Provider Demographics
NPI:1801929294
Name:WIECZOREK, MARK ANTHONY (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:WIECZOREK
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 1:494 BEAR CHRISTIANA RD
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1039
Mailing Address - Country:US
Mailing Address - Phone:215-913-7059
Mailing Address - Fax:302-838-3381
Practice Address - Street 1:494 BEAR CHRISTIANA RD
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1039
Practice Address - Country:US
Practice Address - Phone:610-361-9768
Practice Address - Fax:610-361-9766
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-030059-L122300000X
DEG1-0001204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist