Healthcare Provider Details

I. General information

NPI: 1811791973
Provider Name (Legal Business Name): MARK GIRGIS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2843 SE 17TH ST
OCALA FL
34471-5516
US

IV. Provider business mailing address

2843 SE 17TH ST
OCALA FL
34471-5516
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: