Healthcare Provider Details

I. General information

NPI: 1023272325
Provider Name (Legal Business Name): MARK HAGIGI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MEHRDAD HAGHIGHI DDS

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 SHADY GROVE RD SUITE 208
ROCKVILLE MD
20850-3218
US

IV. Provider business mailing address

15200 SHADY GROVE RD SUITE 208
ROCKVILLE MD
20850-3218
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-2600
  • Fax: 301-208-6657
Mailing address:
  • Phone: 301-869-2600
  • Fax: 301-208-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN1001560
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number16095
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number053887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: