MEDICARE: DRS MABE & MABE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	104574	NC
2	122300000X	Dentist	104509	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093726929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS MABE & MABE PA

Provider Business Mailing Address
First Line	:	PO BOX 648
Second Line	:
City	:	WALNUT COVE
State	:	NC
Zip	:	27052
Country	:	US
Telephone Number	:	336-591-4303
Fax Number	:	336-591-4516

Provider Business Practice Location Address
First Line	:	1218 N MAIN STREET
Second Line	:
City	:	WALNUT COVE
State	:	NC
Zip	:	27052
Country	:	US
Telephone Number	:	336-591-4303
Fax Number	:	336-591-4516

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TIM MABE
Credential	:	DDS
Telephone Number	:	336-591-4303

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/22/2020

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Directions to “DRS MABE & MABE PA ” Practice Location

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