Provider Demographics
NPI:1962744987
Name:GOBBEL, MARK TILDEN (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:TILDEN
Last Name:GOBBEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2530 LAWRENCEVILLE HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3238
Mailing Address - Country:US
Mailing Address - Phone:770-939-9779
Mailing Address - Fax:770-939-2393
Practice Address - Street 1:2530 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3238
Practice Address - Country:US
Practice Address - Phone:770-939-9779
Practice Address - Fax:770-939-2393
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice