Individual
DR. MARK R STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1430 JOHN WESLEY GILBERT DRIVE, AUGUSTA, GA 30912-0004
(706) 721-9744
(706) 721-6778
Mailing address
1430 JOHN WESLEY GILBERT DRIVE GC-1012, AUGUSTA, GA 30912-0001
(706) 721-7913
(706) 721-6778
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
DDS25997
CA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
DN013387
GA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
DN7757
FL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
DNGA000215
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
589724798B
—
GA
05
—
589724798I
—
GA
05
—
ZG3387
—
SC
Enumeration date
07/24/2006
Last updated
03/22/2021
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