MEDICARE: DR. MARK ANDREW STRANDBURG DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN014089	GA

General Provider Information

NPI Number	:	1841519840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ANDREW STRANDBURG DMD

Provider Business Mailing Address
First Line	:	1273 S HOUSTON LAKE RD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2708
Country	:	US
Telephone Number	:	478-287-2179
Fax Number	:	478-287-6162

Provider Business Practice Location Address
First Line	:	1273 S HOUSTON LAKE RD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2708
Country	:	US
Telephone Number	:	478-287-2179
Fax Number	:	478-287-6162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2010
Last Update Date	:	07/14/2015

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