Provider Demographics
NPI:1831130780
Name:PABST, MARK DELL III (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DELL
Last Name:PABST
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2799 S CHARLES ST
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:252-355-2214
Practice Address - Street 1:2799 S CHARLES ST
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:252-355-2214
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996588Medicaid
NCA00161Medicare UPIN