MEDICARE: MARK ALAN SLABBEKOORN DDS, MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	24023	TX

General Provider Information

NPI Number	:	1861489825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALAN SLABBEKOORN DDS, MD

Provider Business Mailing Address
First Line	:	1000 N OAK AVE
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-5703
Country	:	US
Telephone Number	:	715-387-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 LAKELAND DR
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-1687
Country	:	US
Telephone Number	:	715-738-2000
Fax Number	:

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	09/21/2011

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