Provider Demographics
NPI:1447486576
Name:MARS DENTAL SPECIALISTS
Entity type:Organization
Organization Name:MARS DENTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KREASHKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MDS
Authorized Official - Phone:724-625-7200
Mailing Address - Street 1:160 BRICKYARD RAOD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046
Mailing Address - Country:US
Mailing Address - Phone:724-625-7200
Mailing Address - Fax:
Practice Address - Street 1:160 BRICKYARD RAOD
Practice Address - Street 2:SUITE 500
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046
Practice Address - Country:US
Practice Address - Phone:724-625-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0376881223P0221X
PADS026386L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty