Provider Demographics
NPI:1710039482
Name:MARK D. PABST FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MARK D. PABST FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:PABST
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:252-355-2300
Mailing Address - Street 1:2799 CHARLES BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5933
Mailing Address - Country:US
Mailing Address - Phone:252-355-2300
Mailing Address - Fax:
Practice Address - Street 1:2799 CHARLES BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5933
Practice Address - Country:US
Practice Address - Phone:252-355-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831130780OtherINDIVIDUAL NPI
NC8996588Medicaid