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General NPI Number Information
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NPI Number | 1417035395
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Entity Type | Individual
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Provider Name | MARK L MASHBURN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 1400 COLLEGE DR STE 204
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City | TEXARKANA
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State | TX
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Zip | 75503-3575
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Country | US
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Telephone | 903-791-1110
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Fax | 903-791-9353
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Provider Business Mailing Address
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Address Line | PO BOX 1326
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City | MARSHALL
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State | TX
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Zip | 75671-1326
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Country | US
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Telephone | 903-927-3782
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Fax | 903-927-1764
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22854
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3526
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22854
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License Number State | TX
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