Healthcare Provider Details

I. General information

NPI: 1679538136
Provider Name (Legal Business Name): MARK STEVEN STEIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FRANKLIN STREET
FREEPORT PA
16229-1218
US

IV. Provider business mailing address

PO BOX 147
FREEPORT PA
16229
US

V. Phone/Fax

Practice location:
  • Phone: 724-295-5118
  • Fax: 724-295-5119
Mailing address:
  • Phone: 724-295-5118
  • Fax: 724-295-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS024238L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: