Individual provider Active NPI

Stephen J. Markham, D.D.S.

  • Dentist
  • Federal Way, WA
National Provider Identifier
1265420194
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE00011088 Issued in WA
Practice address
720 S 320TH St Ste I
Federal Way, WA 98003-5254
Phone
(253) 839-5953
NPI assigned
Oct 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DD1803 NM
Dentist 122300000X DE00011088 WA Primary

Addresses

Primary practice location

720 S 320TH St Ste I
Federal Way, WA 98003-5254

Mailing address

3305 S 255TH St Ste B
Kent, WA 98032-5660
Phone (575) 288-5172

Other identifiers 1

IdentifierTypeStateIssuer
94827532MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DD1803NMMDDentist
DE00011088WAMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1265420194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3305 S 255TH ST STE B",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980325660",
            "telephone_number": "575-288-5172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 S 320TH ST STE I",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980035254",
            "telephone_number": "253-839-5953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARKHAM",
        "first_name": "STEPHEN",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD1803",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00011088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "94827532",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.