MEDICARE: DR. MARK ANTHONY VENINCASA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	15273	TX

General Provider Information

NPI Number	:	1255370060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ANTHONY VENINCASA DDS

Provider Business Mailing Address
First Line	:	17330 PRESTON RD
Second Line	:	SUITE 116-D
City	:	DALLAS
State	:	TX
Zip	:	75252-5728
Country	:	US
Telephone Number	:	972-250-2580
Fax Number	:	972-250-0134

Provider Business Practice Location Address
First Line	:	17330 PRESTON RD
Second Line	:	SUITE 116-D
City	:	DALLAS
State	:	TX
Zip	:	75252-5728
Country	:	US
Telephone Number	:	972-250-2580
Fax Number	:	972-250-0134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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