Provider Demographics
NPI:1932302528
Name:MARKOFSKY, STEWART S (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:S
Last Name:MARKOFSKY
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 1:3326 FORT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-3627
Mailing Address - Country:US
Mailing Address - Phone:313-381-0343
Mailing Address - Fax:313-386-0331
Practice Address - Street 1:3326 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-3627
Practice Address - Country:US
Practice Address - Phone:313-381-0343
Practice Address - Fax:313-386-0331
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12305122300000X
MI29010123051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist