Healthcare Provider Details

I. General information

NPI: 1649679085
Provider Name (Legal Business Name): WAYNE STEPHENS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5607 NW 27TH AVE SUITE 2
MIAMI FL
33142-2826
US

IV. Provider business mailing address

808 S 5TH AVE
DENTON MD
21629-1398
US

V. Phone/Fax

Practice location:
  • Phone: 305-636-3336
  • Fax:
Mailing address:
  • Phone: 410-479-2650
  • Fax: 833-916-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0562251
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN20205
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number18018
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: