Healthcare Provider Details

I. General information

NPI: 1053321570
Provider Name (Legal Business Name): MARK PATRICK TOMPKINS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

19109 WEST CATAWBA AVE SUITE 108
CORNELIUS NC
28031
US

IV. Provider business mailing address

19109 WEST CATAWBA AVE SUITE 108
CORNELIUS NC
28031
US

V. Phone/Fax

Practice location:
  • Phone: 704-895-3833
  • Fax: 704-895-3656
Mailing address:
  • Phone: 704-895-3833
  • Fax: 704-895-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6884
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: