Healthcare Provider Details

I. General information

NPI: 1316989411
Provider Name (Legal Business Name): JULIUS A STEPHENS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 SUMMERHILL RD
NORTH AUGUSTA SC
29841-3067
US

IV. Provider business mailing address

1604 SUMMERHILL RD
NORTH AUGUSTA SC
29841-3067
US

V. Phone/Fax

Practice location:
  • Phone: 803-279-6743
  • Fax: 803-279-9956
Mailing address:
  • Phone: 803-279-6743
  • Fax: 803-279-9956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2061
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8825
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: