Healthcare Provider Details

I. General information

NPI: 1265552491
Provider Name (Legal Business Name): MARK EDWARD BEICKE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 02/28/2021
Certification Date: 02/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PARKWAY CTR SUITE G-1
PITTSBURGH PA
15220-3510
US

IV. Provider business mailing address

2 PARKWAY CTR STE G1
PITTSBURGH PA
15220-3510
US

V. Phone/Fax

Practice location:
  • Phone: 412-937-1900
  • Fax:
Mailing address:
  • Phone: 412-551-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS037360
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30 - 021422
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-17370
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberDA031621
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: