Provider Demographics
NPI:1558584045
Name:HAMBLIN, MARK S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:HAMBLIN
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 1:6755 E SUPERSTITION SPRINGS BLVD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4373
Mailing Address - Country:US
Mailing Address - Phone:480-981-3311
Mailing Address - Fax:
Practice Address - Street 1:6755 E SUPERSTITION SPRINGS BLVD
Practice Address - Street 2:SUITE #202
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4373
Practice Address - Country:US
Practice Address - Phone:480-981-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice