# DR. MARK NISSENBAUM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1902897184
- **Gender:** Man
- **Credential:** DMD MDC FCDSA OMFS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 8460 | MA | Yes |

## Other

- **Enumeration date:** 11/04/2005
- **Last updated:** 02/27/2014