Provider Demographics
NPI:1861793382
Name:STITES, MARK LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LAWRENCE
Last Name:STITES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 TAMIAMI TRL N
Mailing Address - Street 2:SUITE SIX
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3193
Mailing Address - Country:US
Mailing Address - Phone:239-263-2636
Mailing Address - Fax:239-263-1084
Practice Address - Street 1:4444 TAMIAMI TRL N
Practice Address - Street 2:SUITE SIX
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3193
Practice Address - Country:US
Practice Address - Phone:239-263-2636
Practice Address - Fax:239-263-1084
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL76121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice