Individual
DR. MARK DAVID LIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
106 COLORADO AVE, STUART, FL 34994-2106
(772) 287-3999
(772) 287-1719
Mailing address
106 COLORADO AVE, STUART, FL 34994-2106
(772) 287-3999
(772) 287-1719
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN11635
FL
Other
Enumeration date
08/06/2007
Last updated
08/06/2007
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