Provider Demographics
NPI:1992892178
Name:EGBER, MARK EUGENE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EUGENE
Last Name:EGBER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA44071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice