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Individual
DR. MARK NISSENBAUM
Active
Individual
DR. MARK NISSENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD MDC FCDSA OMFS
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
8460
MA
Other
Enumeration date
11/04/2005
Last updated
02/27/2014
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