Provider Demographics
NPI:1962405407
Name:GASBARA, MARK (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GASBARA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 ANNAPOLIS RD
Mailing Address - Street 2:STE 208
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1396
Mailing Address - Country:US
Mailing Address - Phone:410-551-4600
Mailing Address - Fax:410-674-5551
Practice Address - Street 1:1215 ANNAPOLIS RD
Practice Address - Street 2:STE 208
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1396
Practice Address - Country:US
Practice Address - Phone:410-551-4600
Practice Address - Fax:410-674-5551
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD098791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice