Provider Demographics
NPI:1861527160
Name:STEVENS, MARK CURTIS (JD DDS DENTIST ATTOR)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CURTIS
Last Name:STEVENS
Suffix:
Gender:M
Credentials:JD DDS DENTIST ATTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10159
Mailing Address - Country:US
Mailing Address - Phone:212-679-2472
Mailing Address - Fax:
Practice Address - Street 1:460 2ND AVE
Practice Address - Street 2:SUITE 8B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-385-4666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033102DENTIST1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics