Individual
MR. DARRYL LEO MABRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
125 EAST WARD STREET, SPRINGFIELD, OH 45504-2205
(937) 324-0095
(937) 325-4626
Mailing address
125 EAST WARD STREET, SPRINGFIELD, OH 45504-2205
(937) 324-0095
(937) 325-4626
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
16529
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0749604
—
OH
01
—
29854
CARE SOURCE
OH
Enumeration date
10/05/2006
Last updated
07/08/2007
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