Provider Demographics
NPI:1245311190
Name:SCRIBBINS, MARK J (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:SCRIBBINS
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 1:108 S 4TH ST
Mailing Address - Street 2:PO BOX 65
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1940
Mailing Address - Country:US
Mailing Address - Phone:641-357-3315
Mailing Address - Fax:641-357-3376
Practice Address - Street 1:108 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1940
Practice Address - Country:US
Practice Address - Phone:641-357-3315
Practice Address - Fax:641-357-3376
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA68091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA271054657OtherTTIN
IA0193417OtherPROVIDER ID
IA6809OtherLICENSE NUMBER
IA6809OtherLICENSE NUMBER