Provider Demographics
NPI:1689898314
Name:STENVALL, MARK W (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:STENVALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:410 STATE ROUTE 10
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-9658
Mailing Address - Country:US
Mailing Address - Phone:973-598-0800
Mailing Address - Fax:973-598-0805
Practice Address - Street 1:410 STATE ROUTE 10
Practice Address - Street 2:SUITE 209
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852-9658
Practice Address - Country:US
Practice Address - Phone:973-598-0800
Practice Address - Fax:973-598-0805
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0136631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice