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NPI Code Detail

MEDICARE: DR. MARK J JANOSKY D.M.D.

MEDICARE: DR. MARK J JANOSKY D.M.D.
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
11223G0001XGeneral Practice Dentistry7933NC
2122300000XDentist4418SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19021POTHERNCBLUECROSS BLUESHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811943798
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK J JANOSKY D.M.D.
Provider Business Mailing Address
First Line : P.O. BOX 547
Second Line :
City : LITTLE RIVER
State : SC
Zip : 29566-0547
Country : US
Telephone Number : 843-663-8000
Fax Number : 843-663-8123
Provider Business Practice Location Address
First Line : 4220 CAROLINA EXCHANGE DRIVE
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29579-4220
Country : US
Telephone Number : 843-663-8000
Fax Number : 843-663-8123
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 02/10/2020

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