Provider Demographics
NPI:1225127012
Name:STOVER, MARK ROSS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROSS
Last Name:STOVER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 EAST PENNSYLVANIA AVE.
Mailing Address - Street 2:
Mailing Address - City:ORELAND
Mailing Address - State:PA
Mailing Address - Zip Code:19075
Mailing Address - Country:US
Mailing Address - Phone:215-572-7246
Mailing Address - Fax:215-572-7286
Practice Address - Street 1:214 EAST PENNSYLVANIA AVE.
Practice Address - Street 2:
Practice Address - City:ORELAND
Practice Address - State:PA
Practice Address - Zip Code:19075
Practice Address - Country:US
Practice Address - Phone:215-572-7246
Practice Address - Fax:215-572-7286
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-022848-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice