Individual
DR. MARK J JANOSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
4220 CAROLINA EXCHANGE DRIVE, MYRTLE BEACH, SC 29579-4220
(843) 663-8000
(843) 663-8123
Mailing address
P.O. BOX 547, LITTLE RIVER, SC 29566-0547
(843) 663-8000
(843) 663-8123
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4418
SC
1223G0001X
General Practice Dentistry
7933
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5900834
—
NC
01
—
9021P
BLUECROSS BLUESHIELD
NC
Enumeration date
05/25/2006
Last updated
02/10/2020
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