=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962425454
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK ALLEN BABBITT DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 05/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3088 TELEGRAPH RD STE. C
-----------------------------------------------------
City | VENTURA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93003-3234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-653-1775
-----------------------------------------------------
Fax | 805-653-0790
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3088 TELEGRAPH RD SUITE C
-----------------------------------------------------
City | VENTURA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93003-3234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-653-1775
-----------------------------------------------------
Fax | 805-653-0790
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 43893
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------