Individual
DR. MARK G PRUSACKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
16415 S 46TH WAY, PHOENIX, AZ 85048-0158
(480) 567-4212
Mailing address
16415 S 46TH WAY, PHOENIX, AZ 85048-0158
(480) 753-0529
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4705
AZ
Other
Enumeration date
05/14/2007
Last updated
06/27/2013
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