Provider Demographics
NPI:1568587301
Name:REBER, MARK A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:REBER
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:1049 COCHRANE RD
Mailing Address - Street 2:#110
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-9081
Mailing Address - Country:US
Mailing Address - Phone:408-778-4440
Mailing Address - Fax:408-778-8338
Practice Address - Street 1:1049 COCHRANE RD
Practice Address - Street 2:#110
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-9081
Practice Address - Country:US
Practice Address - Phone:408-778-4440
Practice Address - Fax:408-778-8338
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA336521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770255788Medicare UPIN