# MARK S. GRESKOVICH DMD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518281351
- **Authorized official:** MRS. LORI BROCK (MGR)
- **Authorized official phone:** (850) 477-1125

## Contact information

- **Practice address:** 4850 N 9TH AVE STE 4, PENSACOLA, FL 32503-2406
- **Practice address phone:** (850) 477-1125
- **Practice address fax:** (850) 477-1125
- **Mailing address:** 4850 N 9TH AVE STE 4, PENSACOLA, FL 32503-2406

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DN0011988 | FL | Yes |

## Other

- **Enumeration date:** 03/23/2010
- **Last updated:** 03/23/2010