MEDICARE: DR. MARK A SOCCIO D.M.D.

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	1223G0001X	General Practice Dentistry	DS025987-L	PA

General Provider Information

NPI Number	:	1336263961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A SOCCIO D.M.D.

Provider Business Mailing Address
First Line	:	510 PELLIS RD
Second Line	:	SUITE 202
City	:	GREENSBURG
State	:	PA
Zip	:	15601-4583
Country	:	US
Telephone Number	:	724-837-8030
Fax Number	:	724-837-8031

Provider Business Practice Location Address
First Line	:	510 PELLIS RD
Second Line	:	SUITE 202
City	:	GREENSBURG
State	:	PA
Zip	:	15601-4583
Country	:	US
Telephone Number	:	724-837-8030
Fax Number	:	724-837-8031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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