Provider Demographics
NPI:1912579186
Name:GIRGIS, MARK EMIL (DMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EMIL
Last Name:GIRGIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9906 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3207
Mailing Address - Country:US
Mailing Address - Phone:562-382-6008
Mailing Address - Fax:
Practice Address - Street 1:9906 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3207
Practice Address - Country:US
Practice Address - Phone:562-382-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106573122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist