Individual
DR. MARK ANDREW STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-1246
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-8107
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019.028331
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
021002666
IL
Other
Enumeration date
06/20/2010
Last updated
08/19/2015
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