Provider Demographics
NPI:1134252364
Name:MAGURA, MARK DAVID (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:MAGURA
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8679 CONNECTICUT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6386
Mailing Address - Country:US
Mailing Address - Phone:219-769-1166
Mailing Address - Fax:219-769-4030
Practice Address - Street 1:8679 CONNECTICUT ST
Practice Address - Street 2:SUITE C
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6386
Practice Address - Country:US
Practice Address - Phone:219-769-1166
Practice Address - Fax:219-769-4030
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008922A1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics