Healthcare Provider Details

I. General information

NPI: 1609987338
Provider Name (Legal Business Name): MARK D. SCHENKMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 COMMONWEALTH AVE
ATTLEBORO FALLS MA
02763-1015
US

IV. Provider business mailing address

53 PEARL ST
NORTH ATTLEBORO MA
02760-6612
US

V. Phone/Fax

Practice location:
  • Phone: 508-699-0449
  • Fax: 508-699-4344
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number21387
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN02881
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: