| St. Mark Family Dental | |
|
20913 Sherman Way Canoga Park CA 91303-1743 | |
| (818) 992-4600 | |
| (818) 992-4602 |
| Full Name | St. Mark Family Dental |
|---|---|
| Speciality | Dentist |
| Location | 20913 Sherman Way, Canoga Park, California |
| Authorized Official Name and Position | Maged M Elnaggar (DENTIST) |
| Authorized Official Contact | 8186678257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Mark Family Dental 20913 Sherman Way Canoga Park CA 91303-1743 Ph: (818) 992-4600 | St. Mark Family Dental 20913 Sherman Way Canoga Park CA 91303-1743 Ph: (818) 992-4600 |
| NPI Number | 1427447028 |
|---|---|
| Provider Enumeration Date | 01/20/2015 |
| Last Update Date | 08/05/2020 |
| Medicare PECOS PAC ID | 5799100699 |
|---|---|
| Medicare Enrollment ID | O20200810002141 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427447028 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 60170 (California) | Primary |
| Provider Name | Maged Mina Elnaggar |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1912203100 PECOS PAC ID: 6608291505 Enrollment ID: I20200811001753 |
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