Provider Demographics
NPI:1295748796
Name:GURMAN, MARK S (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:GURMAN
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 1:791 AQUAHART RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3961
Mailing Address - Country:US
Mailing Address - Phone:240-475-3911
Mailing Address - Fax:
Practice Address - Street 1:791 AQUAHART RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3961
Practice Address - Country:US
Practice Address - Phone:240-475-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD87381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521549203OtherTAX ID #
MD568622OtherUNITED CONCORDIA PROVIDER
MD3126OtherCAREFIRST PROVIDER #