MEDICARE: DR. MARK RICHARD 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	5422	NC

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	:	1902955685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK RICHARD STEPHENSON D. D. S.

Provider Business Mailing Address
First Line	:	6260 GLENWOOD AVE
Second Line	:	SUITE 106
City	:	RALEIGH
State	:	NC
Zip	:	27612-2650
Country	:	US
Telephone Number	:	919-782-7275
Fax Number	:	866-509-6275

Provider Business Practice Location Address
First Line	:	6260 GLENWOOD AVE
Second Line	:	SUITE 106
City	:	RALEIGH
State	:	NC
Zip	:	27612-2650
Country	:	US
Telephone Number	:	919-782-7275
Fax Number	:	866-509-6275

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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