MEDICARE: DONALD S. MARKS DDS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	030515	NY
2	122300000X	Dentist	035685	NY

General Provider Information

NPI Number	:	1043307259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD S. MARKS DDS, P.C.

Provider Business Mailing Address
First Line	:	450 PARK AVENUE SOUTH
Second Line	:	SUITE 200
City	:	NEW YORK
State	:	NY
Zip	:	10016-7320
Country	:	US
Telephone Number	:	212-725-6001
Fax Number	:	212-725-6090

Provider Business Practice Location Address
First Line	:	450 PARK AVENUE SOUTH
Second Line	:	SUITE 200
City	:	NEW YORK
State	:	NY
Zip	:	10016-7320
Country	:	US
Telephone Number	:	212-725-6001
Fax Number	:	212-725-6090

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD S MARKS
Credential	:	DDS
Telephone Number	:	212-725-6001

Provider Enumeration Date	:	10/07/2006
Last Update Date	:	06/09/2015

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