Provider Demographics
NPI:1053321570
Name:TOMPKINS, MARK PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PATRICK
Last Name:TOMPKINS
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 1:19109 WEST CATAWBA AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031
Mailing Address - Country:US
Mailing Address - Phone:704-895-3833
Mailing Address - Fax:704-895-3656
Practice Address - Street 1:19109 WEST CATAWBA AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031
Practice Address - Country:US
Practice Address - Phone:704-895-3833
Practice Address - Fax:704-895-3656
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist