Provider Demographics
NPI:1497817662
Name:STEVENS, HOWARD MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MARK
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:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39043-0315
Mailing Address - Country:US
Mailing Address - Phone:601-825-3807
Mailing Address - Fax:601-825-7507
Practice Address - Street 1:1350 W GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3050
Practice Address - Country:US
Practice Address - Phone:601-825-3807
Practice Address - Fax:601-825-7507
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1813-781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice