Healthcare Provider Details

I. General information

NPI: 1578833174
Provider Name (Legal Business Name): MARK A STRAKA DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 OLENTANGY RIVER RD SUITE 125
COLUMBUS OH
43214-3907
US

IV. Provider business mailing address

3545 OLENTANGY RIVER RD SUITE 125
COLUMBUS OH
43214-3907
US

V. Phone/Fax

Practice location:
  • Phone: 614-267-0385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK A STRAKA
Title or Position: OWNER
Credential: DDS
Phone: 614-267-0385