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General NPI Number Information
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NPI Number | 1861527160
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Entity Type | Individual
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Provider Name | MARK CURTIS STEVENS JD DDS DENTIST ATTOR
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Gender | Male
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 460 2ND AVE SUITE 8B
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City | NEW YORK
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State | NY
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Zip | 10016
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Country | US
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Telephone | 212-385-4666
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 495
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City | NEW YORK
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State | NY
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Zip | 10159
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Country | US
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Telephone | 212-679-2472
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 033102DENTIST
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License Number State | NY
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