Healthcare Provider Details

I. General information

NPI: 1841777547
Provider Name (Legal Business Name): MARK HENRY NAGORKA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4774 MUNSON ST NW STE 102
CANTON OH
44718-3634
US

IV. Provider business mailing address

721 MOORE RD STE 304B
AKRON OH
44319-5218
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-6653
  • Fax: 330-494-6630
Mailing address:
  • Phone: 248-705-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30.028086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: