Provider Demographics
NPI:1528300472
Name:DEMARIA, MARK EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:DEMARIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:186 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALEXANDRIA
Mailing Address - State:PA
Mailing Address - Zip Code:15670-2768
Mailing Address - Country:US
Mailing Address - Phone:724-600-4512
Mailing Address - Fax:724-668-2289
Practice Address - Street 1:186 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:NEW ALEXANDRIA
Practice Address - State:PA
Practice Address - Zip Code:15670-2768
Practice Address - Country:US
Practice Address - Phone:724-600-4512
Practice Address - Fax:724-668-2289
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS0392101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics