Provider Demographics
NPI:1750501771
Name:STEPHENS, MARK CLAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CLAY
Last Name:STEPHENS
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 1:138 N KEENELAND DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7951
Mailing Address - Country:US
Mailing Address - Phone:859-626-0069
Mailing Address - Fax:859-626-0402
Practice Address - Street 1:138 N KEENELAND DR
Practice Address - Street 2:SUITE C
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7951
Practice Address - Country:US
Practice Address - Phone:859-626-0069
Practice Address - Fax:859-626-0402
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY73071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice