Provider Demographics
NPI:1174609747
Name:BYDALEK, MARK R (DMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:BYDALEK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:528 ROSEMONT RINGOES RD
Mailing Address - City:SERGEANTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08557
Mailing Address - Country:US
Mailing Address - Phone:609-397-8833
Mailing Address - Fax:609-397-0362
Practice Address - Street 1:528 ROSEMONT RINGOES RD
Practice Address - Street 2:
Practice Address - City:SERGEANTSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08557
Practice Address - Country:US
Practice Address - Phone:609-397-8833
Practice Address - Fax:609-397-0362
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI165371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDI16537OtherDELTA DENTAL OF NJ