Provider Demographics
NPI:1174742456
Name:BABER, MARK ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:BABER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:591 S HORSEBARN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8710
Mailing Address - Country:US
Mailing Address - Phone:479-636-3979
Mailing Address - Fax:479-636-0800
Practice Address - Street 1:591 S HORSEBARN RD STE 100
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8710
Practice Address - Country:US
Practice Address - Phone:479-636-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3594204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166330679Medicaid