Provider Demographics
NPI:1184701633
Name:CLEARY, MARK H (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:CLEARY
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 1:2010 GREENGATE CENTRE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-1289
Mailing Address - Country:US
Mailing Address - Phone:724-836-5060
Mailing Address - Fax:
Practice Address - Street 1:2010 GREENGATE CENTRE CIR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1289
Practice Address - Country:US
Practice Address - Phone:724-836-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA024829L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist