Provider Demographics
NPI:1023272325
Name:HAGIGI, MARK (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HAGIGI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MEHRDAD
Other - Middle Name:
Other - Last Name:HAGHIGHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:15200 SHADY GROVE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3218
Mailing Address - Country:US
Mailing Address - Phone:301-869-2600
Mailing Address - Fax:301-208-6657
Practice Address - Street 1:15200 SHADY GROVE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3218
Practice Address - Country:US
Practice Address - Phone:301-869-2600
Practice Address - Fax:301-208-6657
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0538871223G0001X
DCDEN1001560122300000X
MD16095122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice