MEDICARE: DR. STEPHEN TODD PHELAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3489	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5Y261	OTHER	AR	BCBS NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508924903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN TODD PHELAN D.D.S.

Provider Business Mailing Address
First Line	:	2102 W PLEASANT GROVE RD
Second Line	:	SUITE 1
City	:	ROGERS
State	:	AR
Zip	:	72758-8242
Country	:	US
Telephone Number	:	479-636-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2102 W PLEASANT GROVE RD
Second Line	:	SUITE 1
City	:	ROGERS
State	:	AR
Zip	:	72758-8242
Country	:	US
Telephone Number	:	479-636-3400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	05/06/2008

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