Provider Demographics
NPI:1962534347
Name:FARINA, MARK S (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:FARINA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:15303 AMBERLY DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2308
Mailing Address - Country:US
Mailing Address - Phone:813-972-2929
Mailing Address - Fax:813-977-1471
Practice Address - Street 1:15303 AMBERLY DR
Practice Address - Street 2:SUITE E
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2308
Practice Address - Country:US
Practice Address - Phone:813-972-2929
Practice Address - Fax:813-977-1471
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL130621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
64995OtherBLUE CROSS BLUE SHIELD
842353OtherUNITED CONCORDIA PROV. #