Provider Demographics
NPI:1609937408
Name:D'ANNA, MARK T (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:D'ANNA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FLAMINGO DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2600
Mailing Address - Country:US
Mailing Address - Phone:813-645-1501
Mailing Address - Fax:813-645-3753
Practice Address - Street 1:101 FLAMINGO DR
Practice Address - Street 2:SUITE D
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2600
Practice Address - Country:US
Practice Address - Phone:813-645-1501
Practice Address - Fax:813-645-3753
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN152801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice