Healthcare Provider Details

I. General information

NPI: 1699735704
Provider Name (Legal Business Name): MARK F SOSOVICKA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 TERRACE ST. SUITE G-32
PITTSBURGH PA
15261-0001
US

IV. Provider business mailing address

9242 HIGHMEADOW RD
ALLISON PARK PA
15101-1912
US

V. Phone/Fax

Practice location:
  • Phone: 412-648-8604
  • Fax: 412-648-3600
Mailing address:
  • Phone: 412-366-1712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS025845L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: