Basic Information
| Provider Information | |||||||||
| NPI: | 1265420194 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKHAM | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3305 S 255TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980325660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5752885172 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21110 MERIDIAN AVE E | ||||||||
| Address2: | |||||||||
| City: | GRAHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983385706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535591660 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DE00011088 | WA | N | Dental Providers | Dentist | 122300000X | DD1803 | NM | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 94827532 | 05 | NM | MEDICAID |