Provider Demographics
NPI:1972987303
Name:HOBBIE, MARK A (DMD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:HOBBIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-9771
Mailing Address - Country:US
Mailing Address - Phone:217-935-5397
Mailing Address - Fax:217-935-4769
Practice Address - Street 1:321 ILLINI DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-9771
Practice Address - Country:US
Practice Address - Phone:217-935-5397
Practice Address - Fax:217-935-4769
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL319.0194501223G0001X
IL019.0302211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice