Provider Demographics
NPI:1306057716
Name:PAUL D. MABE, DDS, CHARTERED
Entity type:Organization
Organization Name:PAUL D. MABE, DDS, CHARTERED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MABE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-856-7123
Mailing Address - Street 1:971 E. LINCOLN LANE
Mailing Address - Street 2:PO BOX 38
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030
Mailing Address - Country:US
Mailing Address - Phone:913-856-7123
Mailing Address - Fax:913-856-7121
Practice Address - Street 1:971 E. LINCOLN LN.
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030
Practice Address - Country:US
Practice Address - Phone:913-856-7123
Practice Address - Fax:913-856-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS66511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty