Provider Demographics
NPI:1003252685
Name:TURNER, MARK EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:TURNER
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 1:197 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10464-1225
Mailing Address - Country:US
Mailing Address - Phone:845-596-8242
Mailing Address - Fax:
Practice Address - Street 1:2410 NW FEDERAL HWY
Practice Address - Street 2:SUITE A-110
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9314
Practice Address - Country:US
Practice Address - Phone:772-692-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL224221223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program