Healthcare Provider Details

I. General information

NPI: 1679861868
Provider Name (Legal Business Name): ROBERT B MABRY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 MISSOURI AVE STE E
LAS CRUCES NM
88011-5091
US

IV. Provider business mailing address

2701 MISSOURI AVE STE E
LAS CRUCES NM
88011-5091
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-8663
  • Fax: 575-526-4593
Mailing address:
  • Phone: 575-523-8663
  • Fax: 575-526-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD3511
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: