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General NPI Number Information
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NPI Number | 1376764092
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Entity Type | Individual
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Provider Name | MARK MARGOLIN
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/23/2007
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Provider Practice Location Address
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Address Line | 8401 N CENTRAL EXPY SUITE 200
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City | DALLAS
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State | TX
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Zip | 75225-4402
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Country | US
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Telephone | 214-890-7777
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Fax | 214-890-7782
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Provider Business Mailing Address
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Address Line | 8401 N CENTRAL EXPY SUITE 200
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City | DALLAS
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State | TX
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Zip | 75225-4402
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Country | US
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Telephone | 214-890-7777
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Fax | 214-890-7782
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 21239
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License Number State | TX
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