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General NPI Number Information
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NPI Number | 1265614861
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Entity Type | Individual
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Provider Name | MARK L GROSKO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 843 N 21ST ST SUITE 103
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City | NEWARK
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State | OH
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Zip | 43055-7273
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Country | US
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Telephone | 740-344-6349
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Fax | 740-344-6350
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Provider Business Mailing Address
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Address Line | 843 N 21ST ST SUITE 103
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City | NEWARK
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State | OH
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Zip | 43055-7273
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Country | US
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Telephone | 740-344-6349
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Fax | 740-344-6350
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 21555
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License Number State | OH
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