Provider Demographics
NPI:1255310280
Name:STEVENS, MARK WADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WADE
Last Name:STEVENS
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 1:9 TULIP LN
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2718
Mailing Address - Country:US
Mailing Address - Phone:413-773-3571
Mailing Address - Fax:
Practice Address - Street 1:41 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-4400
Practice Address - Country:US
Practice Address - Phone:413-586-0320
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice