Provider Demographics
NPI:1104957729
Name:RAGSAC, MARK S (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:RAGSAC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 ALA MOANA BLVD
Mailing Address - Street 2:SUITE 902
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5419
Mailing Address - Country:US
Mailing Address - Phone:808-536-8503
Mailing Address - Fax:808-536-8503
Practice Address - Street 1:677 ALA MOANA BLVD
Practice Address - Street 2:SUITE 902
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5419
Practice Address - Country:US
Practice Address - Phone:808-536-8503
Practice Address - Fax:808-536-8503
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 14221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIS2369-3OtherBLUE CROSS &BLUE SHIELD