Provider Demographics
NPI:1841777547
Name:NAGORKA, MARK HENRY (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:HENRY
Last Name:NAGORKA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N. STATE ST.
Mailing Address - Street 2:DEPT OF ORAL-MAXILLOFACIAL SURGERY AND PATHOLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4505
Mailing Address - Country:US
Mailing Address - Phone:601-984-6090
Mailing Address - Fax:601-984-4949
Practice Address - Street 1:2500 N. STATE ST.
Practice Address - Street 2:DEPT OF ORAL-MAXILLOFACIAL SURGERY AND PATHOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4505
Practice Address - Country:US
Practice Address - Phone:601-984-6090
Practice Address - Fax:601-984-4949
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program