Provider Demographics
NPI:1568500197
Name:MABRY, DONALD MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MICHAEL
Last Name:MABRY
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 1:271 E SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6271
Mailing Address - Country:US
Mailing Address - Phone:817-329-6677
Mailing Address - Fax:817-488-4995
Practice Address - Street 1:271 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE #100
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6271
Practice Address - Country:US
Practice Address - Phone:817-329-6677
Practice Address - Fax:817-488-4995
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10,8921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice