Marwan S Al-Daggistany, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

36795 Issued in TX

Practice address

4451 Autumn Sage Dr
Prosper, TX 75078-1285

Phone

(210) 421-3203

NPI assigned

Oct 4, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1245837152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4451 AUTUMN SAGE DR",
            "city": "PROSPER",
            "state": "TX",
            "postal_code": "750781285",
            "telephone_number": "210-421-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4451 AUTUMN SAGE DR",
            "city": "PROSPER",
            "state": "TX",
            "postal_code": "750781285",
            "telephone_number": "210-421-3203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL-DAGGISTANY",
        "first_name": "MARWAN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-04",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1858846",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "36795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Prosper, TX
• Providers in Prosper, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.