Provider Demographics
NPI:1619724747
Name:MARK J NESBITT DDS LLC
Entity type:Organization
Organization Name:MARK J NESBITT DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NESBITT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:724-316-6968
Mailing Address - Street 1:16616 REMARE RD
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-1603
Mailing Address - Country:US
Mailing Address - Phone:724-316-6968
Mailing Address - Fax:
Practice Address - Street 1:4821 BUTLER RD STE 2B
Practice Address - Street 2:
Practice Address - City:GLYNDON
Practice Address - State:MD
Practice Address - Zip Code:21136-5688
Practice Address - Country:US
Practice Address - Phone:410-833-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty