Provider Demographics
NPI:1538256714
Name:MARK EGBER DDS LTD
Entity type:Organization
Organization Name:MARK EGBER DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:EGBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-256-2556
Mailing Address - Street 1:7887 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-5349
Mailing Address - Country:US
Mailing Address - Phone:703-256-2556
Mailing Address - Fax:703-256-7722
Practice Address - Street 1:7887 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5349
Practice Address - Country:US
Practice Address - Phone:703-256-2556
Practice Address - Fax:703-256-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA44071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty