Healthcare Provider Details

I. General information

NPI: 1215346788
Provider Name (Legal Business Name): DEBORAH STEPHENS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 N. HWY 36
GATESVILLE TX
76528
US

IV. Provider business mailing address

1916 N. HWY 36
GATESVILLE TX
76528
US

V. Phone/Fax

Practice location:
  • Phone: 254-865-2000
  • Fax:
Mailing address:
  • Phone: 254-865-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14083
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: