Provider Demographics
NPI:1588872451
Name:MISITI, MARK A (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MISITI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:A
Other - Last Name:MISITI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:64 METROPOLITAN OVAL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6630
Mailing Address - Country:US
Mailing Address - Phone:718-829-3333
Mailing Address - Fax:
Practice Address - Street 1:64 METROPOLITAN OVAL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6630
Practice Address - Country:US
Practice Address - Phone:718-829-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist