Healthcare Provider Details

I. General information

NPI: 1518696855
Provider Name (Legal Business Name): STEPHIE THERESA CYRIL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10870 W CHARLESTON BLVD STE 170
LAS VEGAS NV
89135-1170
US

IV. Provider business mailing address

6011 35TH LN E
ELLENTON FL
34222-7213
US

V. Phone/Fax

Practice location:
  • Phone: 702-254-6412
  • Fax:
Mailing address:
  • Phone: 772-777-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8479
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: