Mark L Mashburn, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22854 Issued in TX

Practice address

1400 College Dr Ste 204
Texarkana, TX 75503-3575

Phone

(903) 791-1110

Fax

(903) 791-9353

NPI assigned

Nov 1, 2006

Last updated

Aug 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1417035395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1326",
            "city": "MARSHALL",
            "state": "TX",
            "postal_code": "756711326",
            "telephone_number": "903-927-3782",
            "fax_number": "903-927-1764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 COLLEGE DR STE 204",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033575",
            "telephone_number": "903-791-1110",
            "fax_number": "903-791-9353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4306 Texas Blvd",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755033014",
            "country_code": "US",
            "telephone_number": "903-794-5386",
            "fax_number": "903-794-0419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASHBURN",
        "first_name": "MARK",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "22854",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22854",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "3526",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5Y565",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX LICENSE",
            "identifier": "22854",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1746328",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maegan Martin
• Mary Alice Martin, DPM
• Michael R Martin, MD
• Timothy Martinez
• Ashli Kristine Mashburn, HIS
• Maya Mason, LCSW
• Summer Massey, RBT
• Amy Matthews
• Charles Harrison Matthews Jr., M.D.
• Igor Evan Matwijiw, M.D.

• General Practice Dentistry in Texarkana, TX
• Providers in Texarkana, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.