Healthcare Provider Details

I. General information

NPI: 1700888062
Provider Name (Legal Business Name): MARK S. SCURRIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E CHAPEL HILL NELSON HWY STE 410
DURHAM NC
27713-2262
US

IV. Provider business mailing address

1920 E CHAPEL HILL NELSON HWY STE 410
DURHAM NC
27713-2262
US

V. Phone/Fax

Practice location:
  • Phone: 919-544-8106
  • Fax: 919-544-8536
Mailing address:
  • Phone: 919-544-8106
  • Fax: 919-544-8536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number5845
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: