MEDICARE: DR. MARK STEPHENSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	16226	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043232481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK STEPHENSON D.D.S.

Provider Business Mailing Address
First Line	:	500 MEDICAL CENTER BLVD STE 110
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2800
Country	:	US
Telephone Number	:	936-760-2200
Fax Number	:	936-760-2226

Provider Business Practice Location Address
First Line	:	500 MEDICAL CENTER BLVD STE 110
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2800
Country	:	US
Telephone Number	:	936-760-2200
Fax Number	:	936-760-2226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	06/12/2024

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