Individual
MARK I DEGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Contact information
Practice address
6140 S FORT APACHE RD STE 120, LAS VEGAS, NV 89148-6737
(702) 253-9090
(702) 253-9083
Mailing address
4730 S FORT APACHE RD, STE 390, LAS VEGAS, NV 89147-7945
(702) 253-9090
(702) 253-9083
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10535
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598946261
GROUP NPI NUMBER
NV
01
—
200078388
TAX ID
NV
Enumeration date
11/22/2006
Last updated
02/27/2026
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