Provider Demographics
NPI:1891878096
Name:MABERLEY, MARK RONALD (MARK MABERLEY DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RONALD
Last Name:MABERLEY
Suffix:
Gender:M
Credentials:MARK MABERLEY DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 PORTOLA DR
Mailing Address - Street 2:#211
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1234
Mailing Address - Country:US
Mailing Address - Phone:415-751-0166
Mailing Address - Fax:
Practice Address - Street 1:801 PORTOLA DR
Practice Address - Street 2:#211
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1234
Practice Address - Country:US
Practice Address - Phone:415-751-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA309091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice