Provider Demographics
NPI:1841519840
Name:STRANDBURG, MARK ANDREW (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:STRANDBURG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 S HOUSTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2708
Mailing Address - Country:US
Mailing Address - Phone:478-287-2179
Mailing Address - Fax:478-287-6162
Practice Address - Street 1:1273 S HOUSTON LAKE RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2708
Practice Address - Country:US
Practice Address - Phone:478-287-2179
Practice Address - Fax:478-287-6162
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0140891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice