Active NPI
Mark Alan Slabbekoorn, DDS, MD
- Oral and Maxillofacial Surgery (Dentist)
- Chippewa Falls, WI
National Provider Identifier
1861489825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 24023
- Practice address
- 850 Lakeland Dr
Chippewa Falls, WI 54729-1687 - Phone
- (715) 738-2000
- NPI assigned
- Oct 4, 2005
- Last updated
- Sep 21, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 24023 | TX | Primary |
Addresses
Primary practice location
850 Lakeland Dr
Chippewa Falls, WI 54729-1687
Mailing address
1000 N Oak Ave
Marshfield, WI 54449-5703
Phone (715) 387-5511
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24023 | TX | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316563200000",
"number": "1861489825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 N OAK AVE",
"city": "MARSHFIELD",
"state": "WI",
"postal_code": "544495703",
"telephone_number": "715-387-5511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "850 LAKELAND DR",
"city": "CHIPPEWA FALLS",
"state": "WI",
"postal_code": "547291687",
"telephone_number": "715-738-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SLABBEKOORN",
"first_name": "MARK",
"middle_name": "ALAN",
"credential": "DDS, MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-04",
"last_updated": "2011-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "TX",
"license": "24023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chippewa Falls, WI
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- Elizabeth L Slack
- Jodi Lynn Budd Slinde, M.S., CCC-SLP
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- Patricia Mae Smoczyk, M.S. CCC-SLP
- Snowhill Healthcare, LLC (Wissota Health & Regional Vent Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.