Provider Demographics
NPI:1013025352
Name:MABE, TIM (DDS)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:
Last Name:MABE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:WALNUT COVE
Mailing Address - State:NC
Mailing Address - Zip Code:27052
Mailing Address - Country:US
Mailing Address - Phone:336-591-8118
Mailing Address - Fax:336-591-4516
Practice Address - Street 1:1218 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:WALNUTE COVE
Practice Address - State:NC
Practice Address - Zip Code:27052
Practice Address - Country:US
Practice Address - Phone:336-591-4303
Practice Address - Fax:336-591-4516
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8995436OtherUNITED HEALTHCARE
NC8902103Medicaid