Provider Demographics
NPI:1003865221
Name:DEVUYST, MARK STEVEN (DDS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEVEN
Last Name:DEVUYST
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 1:12563 LENNRY AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-1759
Mailing Address - Country:US
Mailing Address - Phone:586-610-6094
Mailing Address - Fax:
Practice Address - Street 1:42855 GARFIELD RD
Practice Address - Street 2:STE.107
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5027
Practice Address - Country:US
Practice Address - Phone:586-416-1625
Practice Address - Fax:586-416-1630
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI184951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice