Provider Demographics
NPI:1093726929
Name:DRS MABE & MABE PA
Entity Type:Organization
Organization Name:DRS MABE & MABE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MABE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-591-4303
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:336-591-4303
Mailing Address - Fax:336-591-4516
Practice Address - Street 1:1218 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:WALNUT 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104509122300000X
NC104574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902103Medicaid