Provider Demographics
NPI:1689762551
Name:SOKOLOV, MARK D (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:SOKOLOV
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 1:7500 BRYAN DAIRY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777
Mailing Address - Country:US
Mailing Address - Phone:727-548-7100
Mailing Address - Fax:727-548-7109
Practice Address - Street 1:7500 BRYAN DAIRY RD
Practice Address - Street 2:SUITE C
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777
Practice Address - Country:US
Practice Address - Phone:727-548-7100
Practice Address - Fax:727-548-7109
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12073122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist