Healthcare Provider Details

I. General information

NPI: 1174608921
Provider Name (Legal Business Name): PATRICK H STEPHENS DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CARL MIDWAY CH RD
AUBURN GA
30011
US

IV. Provider business mailing address

7 CARL MIDWAY CH RD
AUBURN GA
30011
US

V. Phone/Fax

Practice location:
  • Phone: 770-867-6144
  • Fax: 770-867-1904
Mailing address:
  • Phone: 770-867-6144
  • Fax: 770-867-1904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10572
License Number StateGA

VIII. Authorized Official

Name: PATRICIA R STEPHENS
Title or Position: OFFICE MANAGER
Credential:
Phone: 770-867-6144