Individual
MARK W STIVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
12728 19TH AVE SE # 101, EVERETT, WA 98208
(425) 224-4661
Mailing address
12728 19TH AVE SE # 101, EVERETT, WA 98208-6526
(425) 224-4661
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS9908
TN
Other
Enumeration date
07/20/2005
Last updated
07/25/2018
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