Provider Demographics
NPI:1154107308
Name:MARK EDWARD DEMARIA DMD MS PLLC
Entity type:Organization
Organization Name:MARK EDWARD DEMARIA DMD MS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DEMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:724-600-4512
Mailing Address - Street 1:2000 TOWER WAY STE 2030
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5786
Mailing Address - Country:US
Mailing Address - Phone:724-853-1600
Mailing Address - Fax:
Practice Address - Street 1:2000 TOWER WAY STE 2030
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5786
Practice Address - Country:US
Practice Address - Phone:724-853-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty