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Individual
DR. MARK ANTHONY CHISHOM
Active
Individual
DR. MARK ANTHONY CHISHOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN014013
GA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
3253
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117364
UNITED CONCORDIA
—
05
—
ZX3253
—
SC
Enumeration date
05/15/2006
Last updated
04/02/2015
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