Provider Demographics
NPI:1316992852
Name:PIPER, MARK (DMD, MD, PA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PIPER
Suffix:
Gender:M
Credentials:DMD, MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 2ND AVE NE
Mailing Address - Street 2:STE 1006
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3434
Mailing Address - Country:US
Mailing Address - Phone:727-823-3220
Mailing Address - Fax:727-823-7284
Practice Address - Street 1:111 2ND AVE NE
Practice Address - Street 2:STE 1006
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3434
Practice Address - Country:US
Practice Address - Phone:727-823-3220
Practice Address - Fax:727-823-7284
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL105961223S0112X
FLMD134531223S0112X
TNME00410591223S0112X
MA170671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD28053Medicare UPIN