Provider Demographics
NPI:1770390924
Name:MARK GIRGIS, D.M.D.
Entity type:Organization
Organization Name:MARK GIRGIS, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRGIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-753-3383
Mailing Address - Street 1:2710 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8750
Mailing Address - Country:US
Mailing Address - Phone:714-941-9926
Mailing Address - Fax:
Practice Address - Street 1:2710 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8750
Practice Address - Country:US
Practice Address - Phone:714-941-9926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912579186Medicaid