Healthcare Provider Details

I. General information

NPI: 1326044116
Provider Name (Legal Business Name): MARK DINNER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N CHURCH ST STE 209
HAZLETON PA
18202-1455
US

IV. Provider business mailing address

1201 N CHURCH ST STE 209
HAZLETON PA
18202-1455
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-6245
  • Fax:
Mailing address:
  • Phone: 570-459-6245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS019991L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: