Provider Demographics
NPI:1548316094
Name:MARK L GROSKO DDS INC
Entity type:Organization
Organization Name:MARK L GROSKO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROSKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-344-6349
Mailing Address - Street 1:843 N 21ST ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-7273
Mailing Address - Country:US
Mailing Address - Phone:740-344-6349
Mailing Address - Fax:740-344-6350
Practice Address - Street 1:843 N 21ST ST
Practice Address - Street 2:SUITE 103
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-7273
Practice Address - Country:US
Practice Address - Phone:740-344-6349
Practice Address - Fax:740-344-6350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH215551223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH440265OtherSUPERIOR
OH187028OtherCOMPBENEFITS FACILITY #
OH195423983004OtherMEDICAL MUTUAL
OH9185647OtherDORAL PROVIDER ID
OH2424693Medicaid
OH256022OtherCIGNA
OH1400162OtherUNITED CONCORDIA
OH1400162OtherUNITED CONCORDIA