Provider Demographics
NPI:1699735704
Name:SOSOVICKA, MARK F (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:SOSOVICKA
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 1:9242 HIGHMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-1912
Mailing Address - Country:US
Mailing Address - Phone:412-366-1712
Mailing Address - Fax:
Practice Address - Street 1:3501 TERRACE ST.
Practice Address - Street 2:SUITE G-32
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-0001
Practice Address - Country:US
Practice Address - Phone:412-648-8604
Practice Address - Fax:412-648-3600
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025845L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01395266Medicaid
U31502Medicare UPIN
PA01395266Medicaid