Provider Demographics
NPI:1538202122
Name:DRUSKAT, MARK J (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:DRUSKAT
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 1:2727 S. TAMAMI TRAIL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239
Mailing Address - Country:US
Mailing Address - Phone:941-955-8588
Mailing Address - Fax:941-955-6868
Practice Address - Street 1:2727 S TAMIAMI TRL
Practice Address - Street 2:SUITE 1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4524
Practice Address - Country:US
Practice Address - Phone:941-955-8588
Practice Address - Fax:941-955-6868
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00128881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice