Provider Demographics
NPI:1477865756
Name:CAUSEY, MARK STEPHEN (MARK CAUSEY)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:CAUSEY
Suffix:
Gender:M
Credentials:MARK CAUSEY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 KEITH BRIDGE RD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5568
Mailing Address - Country:US
Mailing Address - Phone:678-947-0444
Mailing Address - Fax:
Practice Address - Street 1:3480 KEITH BRIDGE RD
Practice Address - Street 2:SUITE C-1
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5568
Practice Address - Country:US
Practice Address - Phone:678-947-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0141141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics