Provider Demographics
NPI:1609987338
Name:SCHENKMAN, MARK D (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:SCHENKMAN
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 1:53 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-6612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO FALLS
Practice Address - State:MA
Practice Address - Zip Code:02763-1015
Practice Address - Country:US
Practice Address - Phone:508-699-0449
Practice Address - Fax:508-699-4344
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213871223S0112X
RIDEN028811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0208451Medicaid
MA0208451Medicaid