Provider Demographics
NPI:1619319456
Name:NESBITT, MARK JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:NESBITT
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 1:1149 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4119
Mailing Address - Country:US
Mailing Address - Phone:724-316-6968
Mailing Address - Fax:
Practice Address - Street 1:13401 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1243
Practice Address - Country:US
Practice Address - Phone:301-879-8337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2024-04-17
Deactivation Date:2024-03-31
Deactivation Code:
Reactivation Date:2024-04-17
Provider Licenses
StateLicense IDTaxonomies
MD15428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist