DR. MARK ANDREW STEPHENS (NPI# 1255652665) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255652665 |
| Entity Type | Individual |
| Full Name | DR. MARK ANDREW STEPHENS |
| Credential | D.M.D. |
| Practice Address |
101 W University Ave Champaign IL 61820-3909 |
| Practice Telephone | 2173661246 |
| Mailing Telephone | 2173668107 |
| Enumeration Date | 2010-06-20 |
| Last Update Date | 2015-08-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
019.028331 | IL | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
021002666 | IL | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457833915 | Mark Stephens | Registered Nurse | 811 Sw Washington Ave, Lawton, OK 73501-7425 | 2018-08-31 |
| 1750501771 | Mark Clay Stephens | Dentist | 138 N Keeneland Dr, Suite C, Richmond, KY 40475-7951 | 2007-05-01 |
| 1053489401 | Mark Charles Stephens | Pharmacist | 297 Drehersville Rd, Orwigsburg, PA 17961-9603 | 2006-12-02 |
| 1093370603 | Mark Stephens Jr. | Student in an Organized Health Care Education/Training Program | 1000 N Lincoln Blvd, Oklahoma City, OK 73104-3252 | 2019-05-08 |
| 1003282419 | Mark Stephens | Acupuncturist | 1 Church St, New Paltz, NY 12561-1514 | 2015-08-19 |
| 1477960870 | Mark Stephens | Specialist/Technologist | 400 7th St, Bay City, TX 77414-4840 | 2014-07-17 |
| 1609286657 | Mark Anthony Stephens | Pediatrics | University of Kentucky, 800 Rose Street, Lexington, KY 40536-0293 | 2014-04-29 |
| 1699033373 | Mark Thomas Stephens | Ophthalmology | 5494 Glen Lakes Dr, Dallas, TX 75231 | 2012-05-01 |
| 1083992556 | Mark Lane Stephens | Nurse Practitioner | 920 Oliver Rd, Monroe, LA 71201-5702 | 2011-08-01 |
| 1770871568 | Mark D Stephens | Physical Therapist | 5770 S 250 E, Murray, UT 84107 | 2011-07-14 |
| Street Address |
101 W UNIVERSITY AVE |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61820-3909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932102969 | Tamara G Helfer | Specialist | 101 W University Ave, Champaign, IL 61820-3981 | 2005-05-23 |
| 1659984540 | Brickston Mellinger | Pharmacist | 101 W University Ave, Champaign, IL 61820-3909 | 2020-08-28 |
| 1477166841 | Amit Patel | Pharmacist | 101 W University Ave, Champaign, IL 61820-3909 | 2020-08-26 |
| 1790320802 | Amy Beth Kutska | Physician Assistant | 101 W University Ave, Champaign, IL 61820-3981 | 2019-11-12 |
| 1093274912 | Alicia Jo Crabtree | Advanced Practice Midwife | 101 W University Ave, Champaign, IL 61820-3981 | 2019-03-19 |
| 1396231767 | Lauren Ashleigh Frerichs | Nurse Practitioner | 101 W University Ave, Champaign, IL 61820-3909 | 2018-07-09 |
| 1700337474 | Annelise Smith | Advanced Practice Midwife | 101 W University Ave, Champaign, IL 61820-3909 | 2016-10-18 |
| 1750836300 | Lindsay Bustle | Advanced Practice Midwife | 101 W University Ave, Champaign, IL 61820-3981 | 2016-08-23 |
| 1922459650 | Kathryn Corgan Mitchell | Physician Assistant | 101 W University Ave, Champaign, IL 61820 | 2016-06-23 |
| 1639572563 | Jacob Backhoff | Pharmacist | 101 W University Ave, Ste 102, Champaign, IL 61820-3909 | 2014-10-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982217345 | Costco Wholesale Corporation | Pharmacy | 2002 N. Neil St., Champaign, IL 61820 | 2020-08-26 |
| 1255963583 | Jamey Richard Bailey | Social Worker | 701 Devonshire Drive, Bldg C, Suite 206, C-6, Champaign, IL 61820 | 2020-02-05 |
| 1790247443 | Jason Abrams | Counselor | 201 W Springfield Ave., Suite 1002-1003, Champaign, IL 61820 | 2019-04-02 |
| 1184100273 | Janine Rafferty | Pharmacist | 2002 N Neil St, Champaign, IL 61820 | 2018-07-12 |
| 1417475070 | Brodbeck Counseling, PC | Community/Behavioral Health | 301 N. Neil Street Suite 323, Champaign, IL 61820 | 2017-09-05 |
| 1447773726 | Quanata M Pelmore | Nurse's Aide | 508 E. Vine St, Champaign, IL 61820 | 2017-07-19 |
| 1821518127 | Molly Mclay | Social Worker | 309 W Clark St., Champaign, IL 61820 | 2017-06-27 |
| 1396265849 | Lou Echols Chambers | Audiologist | 901 South Sixth Street, Chamapign, IL 61820 | 2017-06-26 |
| 1962874495 | Luciana Angelica Guardini | Social Worker | 100 North Chestnut Street, Suite 244, Champaign, IL 61820 | 2015-10-23 |
| 1538544465 | Cpo Services, Inc. | Prosthetic/Orthotic Supplier | 410 E University Ave Ste 105, Champaign, IL 61820 | 2015-07-21 |
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| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770962375 | Eunsu Jung | Dentist | 1902 N Prospect Ave Ste 1, Champaign, IL 61822-1411 | 2015-05-28 |
| 1144423963 | Theron Waisath | Dentist | 3112 Village Office Pl, Champaign, IL 61822-7680 | 2007-06-08 |
| 1518025394 | Eugene Michael Ozment | Dentist | 3112 Village Office Place, Champaign, IL 61822 | 2006-12-05 |
| 1669540399 | Central Illinois Oral & Maxiofacial Surgery, PC | Dentist | 14 E Anthony Dr, Suite C, Champaign, IL 61820-2748 | 2006-12-01 |
| 1750397501 | Victor Escobar | Dentist | 2917 Crossing Ct Ste A, Champaign, IL 61822-6185 | 2006-08-01 |
| 1265946081 | Omfs Practice Inc. | Dentist | 2917 Crossing Ct Ste A, Champaign, IL 61822-6185 | 2017-12-01 |
| 1215196290 | Affiliates In Oral & Maxillofacial Surgery Ltd | Dentist | 3112 Village Office Pl, Champaign, IL 61822-7680 | 2008-06-05 |
| 1326053851 | Richard P. Bianco | Dentist | 101 W University Ave, Champaign, IL 61820-3909 | 2006-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255986576 | Othman Rezki | Dentist | 1900 W Polk St # 611, Chicago, IL 60612-3723 | 2019-08-04 |
| 1215410584 | David Peterson | Dentist | 1619 Brandywine Ln, Dixon, IL 61021-8757 | 2018-09-12 |
| 1952887374 | Winnebago Braces, LLC. | Dentist | 555 N Court St Ste 110, Rockford, IL 61103-6898 | 2018-07-18 |
| 1093232951 | Robert C. Bosack, Dds & Associates, Ltd | Dentist | 16011 108th Ave Ste A, Orland Park, IL 60467-8787 | 2017-08-23 |
| 1790146132 | Family Millennium Dentistry, Inc. | Dentist | 1342 W Randolph St, Chicago, IL 60607-1522 | 2016-03-13 |
| 1811374945 | Alexandria Hawkins | Dentist | 6050 Brynwood Dr Ste 102, Rockford, IL 61114-6579 | 2015-04-27 |
| 1043607872 | Alissa Nicole Pullos | Dentist | 105 E 1st St Ste 103, Hinsdale, IL 60521 | 2015-04-20 |
| 1538592654 | Matthew Seena Hamedani | Dentist | 3116 Oak Park Ave, Berwyn, IL 60402 | 2013-08-13 |
| 1578907689 | M Timothy Murphy | Dentist | 500 Davis St Ste 509, Evanston, IL 60201-4621 | 2013-04-18 |
| 1104260314 | Cameron James Walker | Dentist | 2160 S 1st Ave Rm 1814, Maywood, IL 60153-3328 | 2013-04-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.